| NPI | 1932845427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 104100000X Social Worker (Licence: OH S.2309683) |
| Additional Taxonomies | 172V00000X Community Health Worker |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2026-02-27 |