| NPI | 1992060974 |
|---|---|
| Former Name | TARA CHRISTINE JACKSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: CA A170207) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A170207) |
| 208000000X Pediatrics (Licence: OH 35-126046) | |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2021-04-08 |