Individual
WILLIAM TODD CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CSA
Contact information
Practice address
305 GREENBRIAR CT, OTISCO, IN 47163-9601
(812) 256-6143
Mailing address
305 GREENBRIAR CT, OTISCO, IN 47163-9601
(812) 256-6143
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
—
—
Other
Enumeration date
01/07/2009
Last updated
01/07/2009
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