Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1003376914 |
---|---|
Provider Name | Raquan Moser |
First Address | Durham, NC 27707-2829 |
Second Address | Charlotte, NC 28206-1395 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2019 |
Last Update Date | 25/03/2019 |