NPI | 1174962955 |
---|---|
Former Name | JACLYN R THOMURE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: KS 61004) |
Additional Taxonomies | 122300000X Dentist (Licence: MO 2013042705) |
Enumeration Date | 2013-06-14 |
Last Update Date | 2023-11-26 |