| NPI | 1508430935 |
|---|---|
| Former Name | ELAINA RENEE CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4351047816) |
| Enumeration Date | 2021-05-19 |
| Last Update Date | 2021-09-07 |