| NPI | 1447644497 |
|---|---|
| Former Name | MALLORY SUSAN SHURTE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: CA A144255) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2021-12-14 |