| NPI | 1639738099 |
|---|---|
| Former Name | BRENNA MARIE KELLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI LP05044) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 280686) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2020-06-28 |