| NPI | 1104844927 |
|---|---|
| Former Name | CHERESSA LISETTE RUPERT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA OA002107) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: PA MA051507) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2016-01-18 |