| NPI | 1447530142 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY DAVID MILLER Sole Owner 505-220-2981 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NM FA0099744) |
| Enumeration Date | 2011-08-25 |
| Last Update Date | 2018-11-13 |