NPI | 1598343253 |
---|---|
Former Name | PAYTON DANIELLE MALONE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: KY TP402) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2022-02858) |
Enumeration Date | 2021-04-01 |
Last Update Date | 2024-08-14 |