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 |