Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1174 | NM |
Y | 103T00000X | Psychologist | 1174 | NM |
N | 102L00000X | Psychologist | 864 | NH |
N | 103T00000X | Psychologist | 864 | NH |
NPI | 1003982174 |
---|---|
Provider Name | Dr. Joseph Alfred Bousquet |
First Address | Albuquerque, NM 87122 |
Second Address | Albuquerque, NM 87122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/11/2006 |
Last Update Date | 05/09/2014 |