| NPI | 1033075148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OH sp997581) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: OH sp997581) |
| Enumeration Date | 2026-01-02 |
| Last Update Date | 2026-07-06 |