| NPI | 1518300144 |
|---|---|
| Other Name | JACK JESSUP |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: VT 047.0123038) |
| Additional Taxonomies | 103TC2200X Psychologist, Clinical Child & Adolescent (Licence: VT 047.0123038) |
| Enumeration Date | 2013-04-13 |
| Last Update Date | 2020-06-17 |