NPI | 1679252399 |
---|---|
Former Name | MACKENZIE MOORE |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: PA MA064615) |
Additional Taxonomies | 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) (Licence: PA MA064615) |
Enumeration Date | 2023-07-12 |
Last Update Date | 2025-01-27 |