| NPI | 1699334656 |
|---|---|
| Former Name | TARA HUMBLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN24652) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2019019153) |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2023-12-27 |