| NPI | 1053700815 |
|---|---|
| Former Name | KELSEY BRIANNA SUPPA |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 2082S0105X Plastic Surgery, Surgery of the Hand (Licence: MD C0005671) |
| Enumeration Date | 2015-01-16 |
| Last Update Date | 2023-11-06 |