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 |