| NPI | 1700412319 |
|---|---|
| Former Name | KELLY BLAKE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: WA OP61575651) |
| Additional Taxonomies | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: HI DOS-2292) |
| 208D00000X General Practice (Licence: HI DOS-2292) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-03-14 |
| Last Update Date | 2024-08-14 |