| NPI | 1134626807 |
|---|---|
| Former Name | KELLY COSTOPOULOS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: FL ME168153) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2018-04-10 |
| Last Update Date | 2024-05-08 |