| NPI | 1326697822 |
|---|---|
| Former Name | TYSA MARIE TRAMP |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: MT DENDENLIC25828) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D11097) |
| Enumeration Date | 2019-09-06 |
| Last Update Date | 2024-09-30 |