Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XG0600X | Occupational Therapist - Gerontology | 1110 | SD |
NPI | 1801451745 |
---|---|
Provider Name | Aaron Irmen |
First Address | Watertown, SD 57201-2614 |
Second Address | Watertown, SD 57201-2614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2019 |
Last Update Date | 06/05/2019 |