NPI | 1699097154 |
---|---|
Former Name | WHITNEY ERIN CLARK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA06673) |
Additional Taxonomies | 363AS0400X Physician Assistant, Surgical |
363AS0400X Physician Assistant, Surgical (Licence: CO PA.0005960) | |
Enumeration Date | 2010-02-24 |
Last Update Date | 2023-02-15 |