| NPI | 1518967462 |
|---|---|
| Former Name | JENNIFER M MOORE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: SC 4409) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2025-01-30 |