| NPI | 1023315017 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN RYAN KURTYKA Organizer 505-247-4900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NM 1148) |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical (Licence: NM 1148) |
| 133V00000X Dietitian, Registered | |
| Enumeration Date | 2011-02-28 |
| Last Update Date | 2023-08-23 |