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 |