| NPI | 1164845251 |
|---|---|
| Former Name | LAURA MOORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA056698) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: PA MA056698) |
| Enumeration Date | 2014-01-27 |
| Last Update Date | 2022-04-04 |