| NPI | 1467985655 |
|---|---|
| Former Name | MALLORY BLAKE BOWDEN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: GA 96840) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: GA 96840) |
| Enumeration Date | 2017-04-05 |
| Last Update Date | 2023-10-11 |