| NPI | 1164950622 |
|---|---|
| Former Name | EMILEE MALLAMS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA059032) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA OA004148) |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2017-05-30 |
| Last Update Date | 2020-06-11 |