| NPI | 1811196488 |
|---|---|
| Other Name | AVIA TERRELL JACKSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NY 006459) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MI 5901002248) |
| Enumeration Date | 2007-07-13 |
| Last Update Date | 2012-05-31 |