| NPI | 1841255494 |
|---|---|
| Former Name | TIBY ALECIA MATHOG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: MI 2901019210) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 21603) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2012-05-18 |