| NPI | 1053964890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.2202629-TRNE) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2019-07-22 |
| Last Update Date | 2023-11-29 |