| NPI | 1780916130 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD RUSSELL Clinical Neuropsychologist 505-429-4679 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: NM 761) |
| Enumeration Date | 2010-02-10 |
| Last Update Date | 2011-03-11 |