| NPI | 1639373509 |
|---|---|
| Former Name | MASHIRA DENISHA JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME 108584) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 141452) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2024-06-14 |