| NPI | 1609719913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: OH PRS.007590) |
| Additional Taxonomies | 175T00000X Peer Specialist (Licence: OH PRS.007590) |
| Enumeration Date | 2026-04-11 |
| Last Update Date | 2026-05-03 |