| NPI | 1285129585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: OH UA045640) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: OH UA45640) |
| Enumeration Date | 2018-06-28 |
| Last Update Date | 2018-07-23 |