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 |