NPI | 1366626814 |
---|---|
Entity Type | Organization |
Authorized Contact | HEMA A SUNDARAM Provider 703-641-9666 |
Organization Subpart ? | No |
Primary Taxonomy | 174400000X Specialist (Licence: MD D0044976) |
Additional Taxonomies | 174400000X Specialist (Licence: VA 0101222212) |
Enumeration Date | 2007-12-19 |
Last Update Date | 2007-12-19 |