| NPI | 1902180243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: OH 1763096) |
| Additional Taxonomies | 174H00000X Health Educator (Licence: OH 1763096) |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2011-10-05 |