| NPI | 1578604963 |
|---|---|
| Former Name | ANDREA MARTIN |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: TN 0000001100) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN PA0000001100) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2019-04-18 |