| NPI | 1649058561 |
|---|---|
| Professional Name | NATHAN IREX JACKSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: CA 101YA0400X) |
| Enumeration Date | 2023-09-20 |
| Last Update Date | 2023-09-20 |