| 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 |