Ilham Derhan Putra is a student in an organized health care education training program in Hartford, CT. The provider is an individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. Ilham Derhan Putra NPI is 1770110389. The provider is registered as an individual entity type.
The NPPES NPI record indicates the provider is a male.
The provider's business location address is:
80 SEYMOUR ST
HARTFORD, CT
ZIP 06102-000
Phone: (773) 501-0676
The enumeration date for this NPI number is 3/24/2020 and was last updated on 3/24/2020.