| NPI | 1467813295 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTEN LUM Owner 505-917-9292 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X (Licence: CA AC17604) |
| Additional Taxonomies | 261Q00000X (Licence: NM 1185) |
| Enumeration Date | 2016-03-07 |
| Last Update Date | 2017-11-02 |