| NPI | 1588494967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: OH 235678) |
| Additional Taxonomies | 172V00000X Community Health Worker (Licence: OH 23567) |
| Enumeration Date | 2024-08-01 |
| Last Update Date | 2024-08-01 |