| NPI | 1194310755 |
|---|---|
| Former Name | KELLIE MARIE WONG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IA 115823) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 363AS0400X Physician Assistant Surgical (Licence: IA 115823) | |
| Enumeration Date | 2021-03-05 |
| Last Update Date | 2023-11-08 |