| NPI | 1710102462 |
|---|---|
| Former Name | KRISTINA MARIE KELLEY |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA 19077) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: CA 19077) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2022-02-11 |