NPI | 1174967723 |
---|---|
Former Name | MALLORY ELIZABETH GLASS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207P00000X Emergency Medicine (Licence: SC 39826) |
Additional Taxonomies | 2080S0010X Pediatrics, Sports Medicine (Licence: SC 39826) |
207QS0010X Family Medicine, Sports Medicine (Licence: SC 39826) | |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2013-04-25 |
Last Update Date | 2020-07-16 |