| NPI | 1326584988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker |
| Additional Taxonomies | 104100000X Social Worker (Licence: OH S.2403806-TRNE) |
| 172V00000X Community Health Worker | |
| Enumeration Date | 2017-01-06 |
| Last Update Date | 2026-01-15 |