| NPI | 1053682328 |
|---|---|
| Former Name | CARRIE SUE MARTIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: FL PA9113924) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 11275) |
| Enumeration Date | 2012-01-19 |
| Last Update Date | 2021-11-02 |