NPI | 1518347095 |
---|---|
Former Name | MICHELLE MARIE CLARK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207K00000X Allergy & Immunology (Licence: DE C1-0013781) |
Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT208882) |
Enumeration Date | 2015-06-01 |
Last Update Date | 2021-03-24 |