| NPI | 1619077187 |
|---|---|
| Former Name | ROGER MACKENZIE MOORE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: OR PA00326) |
| Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: WA PA10001610) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2007-07-08 |