| NPI | 1417575549 |
|---|---|
| Former Name | TARA MARIE KELLER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: DE C50011410) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: DE C5-0011410) |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2020-11-16 |