| NPI | 1386998730 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANTI SHANTI KAUR KHALSA Clinical Director 505-753-4692 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: NM LPCC 1093) |
| Additional Taxonomies | 251S00000X (Licence: CA MFC 28201) |
| Enumeration Date | 2012-11-07 |
| Last Update Date | 2012-11-07 |