| NPI | 1639738099 |
|---|---|
| Former Name | BRENNA MARIE KELLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD20031) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 1022485) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2025-01-28 |