Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | AZ |
NPI | 1053474247 |
---|---|
Provider Name | Michael Gutman |
First Address | Tucson, AZ 95706 |
Second Address | Tucson, AZ 95706 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 26/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
144167 | (05) | AZ |