| NPI | 1518364009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH 0600758) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: OH # S.0600758) |
| 172V00000X Community Health Worker (Licence: OH 0600758) | |
| Enumeration Date | 2014-11-26 |
| Last Update Date | 2022-04-05 |