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 |