| NPI | 1932689742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OH E.2404343) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2024-05-17 |