NPI | 1457753626 |
---|---|
Professional Name | MALLORY JOHANSEN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0004112) |
Additional Taxonomies | 363A00000X Physician Assistant |
Enumeration Date | 2014-09-19 |
Last Update Date | 2015-06-10 |