| NPI | 1346302023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 251C00000X Day Training, Developmentally Disabled Services (Licence: WY OTR-130) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: WY OTR-130) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2014-11-12 |