| NPI | 1932698362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 101Y00000X Counselor (Licence: OH C.2002860-TRNE) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| Enumeration Date | 2018-05-01 |
| Last Update Date | 2021-02-18 |