| NPI | 1083235873 |
|---|---|
| Former Name | KELLY ANN GEWAIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: NC 262754) |
| Enumeration Date | 2020-05-03 |
| Last Update Date | 2020-05-03 |