| NPI | 1548681612 |
|---|---|
| Former Name | ELIZABETH CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.004847) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 11510) |
| Enumeration Date | 2013-12-17 |
| Last Update Date | 2022-07-21 |