| NPI | 1528238441 |
|---|---|
| Former Name | CHRISTINE MARIE KELLY-SHOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: IN 01065503A) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WA MD 60142472) |
| Enumeration Date | 2008-03-06 |
| Last Update Date | 2023-09-21 |