Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | AZ |
NPI | 1053521948 |
---|---|
Provider Name | Mr. Mark Richard Romens |
First Address | Anthem, AZ 85086-1536 |
Second Address | Anthem, AZ 85086-4614 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 26/07/2007 |