| NPI | 1275588634 |
|---|---|
| Former Name | KELLY M VAVRO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC 1085) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: SC 1085) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2011-09-16 |