Individual
JACKSON GRAY
Active
Individual
JACKSON GRAY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
06711
MD
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/23/2020
Last updated
08/11/2022
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