| NPI | 1457628323 |
|---|---|
| Former Name | THERESA MOORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO PA.0004989) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: NJ 25MP00272800) |
| Enumeration Date | 2011-11-21 |
| Last Update Date | 2022-07-21 |