| NPI | 1043306947 |
|---|---|
| Former Name | CONNY TIRTAMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD00040886) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME0083971) |
| 207R00000X Internal Medicine (Licence: CA C52357) | |
| 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: CA C52357) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2007-07-08 |