| NPI | 1316571318 |
|---|---|
| Former Name | MACY ELIZABETH MALCOM |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN016074) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA DN016074) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: GA FC9804229) | |
| Enumeration Date | 2020-02-27 |
| Last Update Date | 2021-08-19 |