Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 030 | AZ |
NPI | 1376662148 |
---|---|
Provider Name | Gabriel K Cousens |
First Address | Patagonia, AZ 85624-0778 |
Second Address | Patagonia, AZ 85624 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2007 |
Last Update Date | 08/07/2007 |