| NPI | 1336147396 |
|---|---|
| Former Name | REGINA CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD071566L) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: DE C1-0007659) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2017-03-20 |