| NPI | 1487114971 |
|---|---|
| Former Name | MOLLYANNE ELIZABETH GIBSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 04-46796) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2019-03-21 |
| Last Update Date | 2022-09-21 |