NPI | 1336400134 |
---|---|
Former Name | RONISHA GALE GRAY |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: OK 6420) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OK 6420) |
Enumeration Date | 2012-06-07 |
Last Update Date | 2019-06-28 |