| NPI | 1104084698 |
|---|---|
| Other Name | JAY JACKSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: CA A103543) |
| Additional Taxonomies | 2086S0122X Surgery Plastic and Reconstructive Surgery (Licence: CA A103543) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2023-03-15 |