NPI | 1033578653 |
---|---|
Professional Name | MATTHEW MITCHELL CLARK |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: VA 0401417451) |
Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TN 10945) |
Enumeration Date | 2016-02-11 |
Last Update Date | 2021-08-27 |