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 |