| NPI | 1598127888 |
|---|---|
| Former Name | CHERYL ANN CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: FL ME140369) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2019-07-11 |