| NPI | 1619603586 |
|---|---|
| Former Name | JUDE GEORGE LAZAR |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YA0400X Counselor Addiction (Substance Use Disorder) (Licence: CA R1476200722) |
| Enumeration Date | 2022-07-25 |
| Last Update Date | 2022-07-25 |