NPI | 1578751582 |
---|---|
Former Name | KELLY J GIRA |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: TN 2169) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: IL 085-003039) |
Enumeration Date | 2007-10-04 |
Last Update Date | 2021-07-23 |