NPI | 1780822676 |
---|---|
Former Name | SARA MARTELL |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60731140) |
Additional Taxonomies | 363AM0700X Physician Assistant, Medical (Licence: SC TL1398) |
363AM0700X Physician Assistant, Medical (Licence: AK 1047) | |
Enumeration Date | 2009-01-30 |
Last Update Date | 2017-03-31 |