NPI | 1750853057 |
---|---|
Former Name | KATHLEEN ANN MEHL |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: 261QR0405X) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
Enumeration Date | 2018-12-26 |
Last Update Date | 2023-08-30 |