| NPI | 1861013658 |
|---|---|
| Former Name | MALLORY GIBSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 57.255313) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2020-05-03 |
| Last Update Date | 2023-06-27 |