NPI | 1023723038 |
---|---|
Former Name | MALLORY AMBER LAFFOON |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95306112) |
Enumeration Date | 2023-01-16 |
Last Update Date | 2023-01-16 |