Individual
DR. JACK EVERETT GROSS
Active
Individual
DR. JACK EVERETT GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
EDD
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
1738
NC
183500000X
Pharmacist
13823
NC
Other
Enumeration date
04/21/2011
Last updated
12/16/2019
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