| NPI | 1003895798 |
|---|---|
| Former Name | KELLY PETRISON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MA06821100) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: NJ 25MA06821100) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2013-01-02 |