| NPI | 1841784311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.2607840-TRNE) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2026-07-29 |