NPI | 1033455266 |
---|---|
Former Name | KATHERINE ANN MOORE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 4616) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: OK 2210) |
Enumeration Date | 2012-12-15 |
Last Update Date | 2018-02-21 |