| NPI | 1972051597 |
|---|---|
| Former Name | SHAQUANA YVETTE CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: VA 0101265182) |
| Enumeration Date | 2016-09-12 |
| Last Update Date | 2023-08-04 |