| NPI | 1821493503 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MILTON C. LASOSKI Registered Agent 505-266-3070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: NM 364) |
| Enumeration Date | 2014-10-24 |
| Last Update Date | 2016-05-17 |