| NPI | 1023531548 |
|---|---|
| Former Name | KELSEY ROETENBERG |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA061108) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WV 2081) |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2020-12-13 |