NPI | 1255714705 |
---|---|
Former Name | MALLORY A WILLIAMS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: IN 01080447A) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: FL TRN 21728) |
Enumeration Date | 2015-07-01 |
Last Update Date | 2018-07-18 |