| NPI | 1528956216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.2614156) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2025-06-24 |
| Last Update Date | 2026-06-26 |