| NPI | 1376569921 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JONATHAN EDWARD LACKNER Partner / M.D. 505-242-3991 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NM 6682460001) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2013-07-31 |