| NPI | 1093686719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: OH CHW.002841) |
| Enumeration Date | 2025-09-16 |
| Last Update Date | 2025-09-16 |