| NPI | 1962031666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: CO 1000158-NP) |
| Additional Taxonomies | 163WX0200X Registered Nurse, Oncology (Licence: CO RN-1632168) |
| Enumeration Date | 2020-04-04 |
| Last Update Date | 2025-03-10 |