| NPI | 1225542285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 405300000X Prevention Professional (Licence: OH OCPSA.4273) | |
| Enumeration Date | 2017-11-28 |
| Last Update Date | 2023-06-29 |