| NPI | 1760663140 |
|---|---|
| Former Name | JODY RUTZ |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: MT MED-PAC-LIC-61430) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: CO 2457) |
| Enumeration Date | 2007-11-14 |
| Last Update Date | 2022-03-03 |