| NPI | 1518209089 |
|---|---|
| Former Name | MALLORY CAMILLE FAULKNER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 55808) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 55808) |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2017-05-22 |