NPI | 1528420700 |
---|---|
Former Name | SAMANTHA ANN MARTIN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD473164) |
Additional Taxonomies | 208000000X Pediatrics (Licence: NY 299816) |
390200000X Student in an Organized Health Care Education/Training Program (Licence: NY 63753) | |
Enumeration Date | 2016-03-25 |
Last Update Date | 2021-10-28 |