| NPI | 1801185541 |
|---|---|
| Former Name | EVELINE RUSDIANTO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OH 34.011721) |
| Additional Taxonomies | 208600000X Surgery (Licence: AR E-15091) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2023-07-19 |