| NPI | 1205575123 |
|---|---|
| Former Name | MALLORY N FANGMAN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133N00000X Nutritionist |
| Additional Taxonomies | 133V00000X Dietitian, Registered |
| Enumeration Date | 2022-05-31 |
| Last Update Date | 2024-05-20 |