| NPI | 1891135158 |
|---|---|
| Former Name | JESSICA KAYE CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207V00000X Obstetrics & Gynecology (Licence: WA OP60747716) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: MI 5101020627) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2019-05-02 |