Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 2018-01257 | NC |
NPI | 1033577101 |
---|---|
Provider Name | Tijo Thomas |
First Address | Marlton, NJ 08053-1776 |
Second Address | Newark, NJ 07102-1909 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2016 |
Last Update Date | 14/09/2021 |