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 |