| 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 |