| NPI | 1811301203 |
|---|---|
| Former Name | MALISSA BLAIR WILSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 37102) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC LL37102) |
| Enumeration Date | 2014-06-13 |
| Last Update Date | 2018-12-27 |