| NPI | 1275580672 |
|---|---|
| Former Name | TERESA KELLY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301052060) |
| Additional Taxonomies | 2085P0229X Radiology, Pediatric Radiology (Licence: WI 52993) |
| 2085P0229X Radiology, Pediatric Radiology (Licence: FL ME70684) | |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2024-11-26 |