| NPI | 1013367440 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHARLES CAPERTON Owner 505-553-3535 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: NM MD2005-0092) |
| Additional Taxonomies | 261QM2500X Clinic/Center Medical Specialty (Licence: NM MD2005-0092) |
| Enumeration Date | 2016-06-16 |
| Last Update Date | 2016-06-16 |