| NPI | 1881945558 |
|---|---|
| Former Name | MALLORY ROSE GESCHKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085004404) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085.004404) |
| Enumeration Date | 2012-09-21 |
| Last Update Date | 2021-08-23 |