| NPI | 1205830007 |
|---|---|
| Other Name | MARK JACKSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: KY 31633) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: IN 01085873A) |
| 207N00000X Dermatology (Licence: TX J8602) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2021-09-17 |