NPI | 1609112515 |
---|---|
Former Name | KAROLYN S MARTIN |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: CO 4953) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: NC 0010-03961) |
363A00000X Physician Assistant (Licence: SC 2486) | |
363AS0400X Physician Assistant, Surgical (Licence: NC 0010 03961) | |
Enumeration Date | 2012-12-20 |
Last Update Date | 2022-03-22 |