| NPI | 1720404833 |
|---|---|
| Former Name | ALISHA CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: NM PA2014-0021) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2014-03-13 |
| Last Update Date | 2014-08-19 |