| NPI | 1871026856 |
|---|---|
| Former Name | KELLY MAE BRANDER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2081S0010X Physical Medicine & Rehabilitation, Sports Medicine (Licence: IL 036157061) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: IL 125.071616) |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2022-07-01 |