| NPI | 1689713018 |
|---|---|
| Other Name | CHARLES E CLARK |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 51554) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NM 96180) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2015-02-03 |