| NPI | 1932557907 |
|---|---|
| Former Name | SYDNEY JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: MI 5601013055) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: FL PA9109523) |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2025-06-09 |