NPI | 1508343112 |
---|---|
Former Name | KELLY MARIE BRAUN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: IN 10004477A) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9114151) |
Enumeration Date | 2018-07-26 |
Last Update Date | 2024-08-16 |