| NPI | 1871749341 |
|---|---|
| Former Name | JULIE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 133VN1004X Dietitian, Registered, Nutrition, Pediatric (Licence: MA 000002758) |
| Enumeration Date | 2008-08-15 |
| Last Update Date | 2012-04-04 |