NPI | 1801435052 |
---|---|
Former Name | REBECCA ELIZABETH CLARK |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: KS 53-78887-112) |
Additional Taxonomies | 261QU0200X Clinic/Center, Urgent Care |
Enumeration Date | 2020-01-04 |
Last Update Date | 2020-01-22 |