| NPI | 1669823829 |
|---|---|
| Former Name | TALITHA MARIE JESSE KHORASANI |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D012005) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 108674) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 103K00000X Behavior Analyst | |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2024-09-19 |