NPI | 1326393455 |
---|---|
Former Name | KARA FAYE GOBBLE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 124Q00000X Dental Hygienist (Licence: VA 0402204467) |
Additional Taxonomies | 126800000X Dental Assistant (Licence: VA 195701) |
Enumeration Date | 2012-07-15 |
Last Update Date | 2012-07-15 |