| NPI | 1164649539 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OH 116469539) | 
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: OH 116469539) | 
| 104100000X Social Worker | |
| Enumeration Date | 2007-04-19 | 
| Last Update Date | 2025-10-23 |