Individual
ESRAVILA ARIYA WIBISONO
Active
Individual
ESRAVILA ARIYA WIBISONO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD61603415
WA
390200000X
Student in an Organized Health Care Education/Training Program
06-0646844
CT
Other
Enumeration date
06/14/2022
Last updated
07/31/2025
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