NPI | 1467514091 |
---|---|
Former Name | COURTNEY A MOYLAN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: NJ 25MP00172800) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: PA MA052442) |
Enumeration Date | 2006-12-13 |
Last Update Date | 2023-11-29 |