| NPI | 1972051803 |
|---|---|
| Former Name | JESSICA CLARK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: FL AA559) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: NM AA2016-005) |
| Enumeration Date | 2016-09-20 |
| Last Update Date | 2024-10-30 |