| NPI | 1013115062 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUDY R COCKBURN Practice Manager 575-751-0334 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NM MD2004-0101) |
| Additional Taxonomies | 174400000X Specialist (Licence: NM 99-256) |
| 174400000X Specialist (Licence: NM 74-132) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2007-11-06 |