NPI | 1790278430 |
---|---|
Former Name | KATHERINE MOSS |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: NC 0010-08161) |
Additional Taxonomies | 363A00000X Physician Assistant |
363AM0700X Physician Assistant, Medical (Licence: PA MA061648) | |
Enumeration Date | 2018-06-07 |
Last Update Date | 2024-04-26 |