NPI | 1114421518 |
---|---|
Former Name | TIORRA JOHNSON ROSS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: TX T3796) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2018-03-20 |
Last Update Date | 2021-10-27 |