NPI | 1871015941 |
---|---|
Former Name | JEROME M MASSAD |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 104100000X Social Worker (Licence: OR L10965) |
Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OR 21-06-30017) |
Enumeration Date | 2017-07-11 |
Last Update Date | 2025-01-06 |