NPI | 1588858039 |
---|---|
Former Name | KELLY L MCCORMICK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 133VN1004X Dietitian, Registered, Nutrition, Pediatric (Licence: MN 1690) |
Enumeration Date | 2007-08-28 |
Last Update Date | 2012-11-30 |