| 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 |