| NPI | 1023500469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.2308917) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2024-08-20 |