| 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 |