| NPI | 1790006773 |
|---|---|
| Former Name | KAITLYN ELIZABETH ELLIS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0120X Surgery, Pediatric Surgery (Licence: MA 287610) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 287610) |
| Enumeration Date | 2010-06-14 |
| Last Update Date | 2023-12-06 |