NPI | 1316506280 |
---|---|
Former Name | SAMANTHA THOMAS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: MO 2019020712) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 61612) |
Enumeration Date | 2019-06-13 |
Last Update Date | 2022-03-23 |