Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 2301005167 | MI |
NPI | 1184669210 |
---|---|
Provider Name | Dr. Daniel Stewart Clark |
First Address | Clinton Township, MI 48038 |
Second Address | Clinton Township, MI 48038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2006 |
Last Update Date | 24/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U 31875 | (02) | MI |