| NPI | 1497773998 |
|---|---|
| Former Name | CLARA MARIE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35-088014) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-088014) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2013-12-23 |