| NPI | 1730524216 |
|---|---|
| Former Name | MARTHA MICHELLE ROARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: TN 54014) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TN 54014) |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2018-04-18 |