NPI | 1144894759 |
---|---|
Former Name | KELLY SUZANNE PAYNE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 208800000X Urology (Licence: MN 71988) |
Additional Taxonomies | 208800000X Urology (Licence: MN 31552) |
Enumeration Date | 2021-05-18 |
Last Update Date | 2022-08-11 |