| NPI | 1366631616 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOEL WILLIAM SIEVERS President/Director 575-226-3023 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NM 2002-0109) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2008-03-12 |