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 |