| NPI | 1427391846 |
|---|---|
| Former Name | KELLI JO DAWSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2019022284) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 62996) |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2019-09-23 |