| NPI | 1154351443 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUPRASAD M RAO Physician 505-807-1508 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center Medical Specialty (Licence: IN 01061494A) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2010-03-12 |