| NPI | 1033357116 |
|---|---|
| Former Name | MICHELLE LYNN EBENROTH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: MO 2009003010) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MO 2009003010) |
| Enumeration Date | 2009-01-28 |
| Last Update Date | 2024-09-12 |