| NPI | 1275928897 |
|---|---|
| Former Name | JILL MALLORY FADAL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 10964555-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 15751A) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0070579) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 35561) | |
| Enumeration Date | 2015-03-31 |
| Last Update Date | 2024-03-04 |