| NPI | 1174999064 |
|---|---|
| Other Name | TANESHA BULLOCKS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A148144) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2015-08-14 |
| Last Update Date | 2022-08-03 |