| NPI | 1982066502 | 
|---|---|
| Former Name | EVAN AMELIA MARTIN | 
| Entity Type | Individual | 
| Gender | Female | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2019015017) | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: KS 04-43587) | 
| Enumeration Date | 2016-03-23 | 
| Last Update Date | 2024-12-30 |