NPI | 1467199083 |
---|---|
Former Name | TERAH LEIGH WILLIS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 122300000X Dentist (Licence: FL DN26857) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
Enumeration Date | 2022-05-16 |
Last Update Date | 2024-05-30 |