| NPI | 1598970642 |
|---|---|
| Former Name | BRENDA MARIE MELLIES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: KS 0433262) |
| Additional Taxonomies | 208600000X Surgery (Licence: NE 26100) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2015-10-07 |