| NPI | 1912701871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: OH TS939670) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OH TS939570) |
| Enumeration Date | 2025-04-01 |
| Last Update Date | 2025-04-01 |