NPI | 1871090837 |
---|---|
Former Name | LYDIA GENEVIEVE CLARK |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: WY 15685A) |
Additional Taxonomies | 2084N0400X Psychiatry & Neurology, Neurology (Licence: UT 11441506-1205) |
Enumeration Date | 2018-04-06 |
Last Update Date | 2023-09-12 |