| NPI | 1578854469 |
|---|---|
| Former Name | TIFFANY MARIE DAVIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 072722) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2014-08-22 |