| NPI | 1235587932 |
|---|---|
| Former Name | TESS MARIE RUDOLPH |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IN 10002761A) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MI 5601007808) |
| Enumeration Date | 2016-06-03 |
| Last Update Date | 2024-09-09 |