| NPI | 1598291791 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MINGLIARTI TJAHJANA Owner/CEO 571-572-9198 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101236144) |
| Enumeration Date | 2017-05-08 |
| Last Update Date | 2017-05-08 |