Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | A108298 | CA |
NPI | 1104010776 |
---|---|
Provider Name | Pim Suwannarat |
First Address | Suitland, MD 20746-4207 |
Second Address | Suitland, MD 20746-4207 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2007 |
Last Update Date | 07/06/2021 |