| NPI | 1508161936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VALERIANE M WILSON President/Director 505-991-5713 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant Surgical (Licence: NM PA2005-0035) |
| Enumeration Date | 2011-01-15 |
| Last Update Date | 2011-01-15 |