NPI | 1144766734 |
---|---|
Professional Name | JASON SCOTT GRUNDSTROM-WHITENY |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: ME LC3358) |
Enumeration Date | 2017-01-06 |
Last Update Date | 2017-01-06 |