Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 610 | NM |
Y | 103T00000X | Psychologist | 610 | NM |
NPI | 1003905126 |
---|---|
Provider Name | John Mark Marsh |
First Address | Taos, NM 87571 |
Second Address | Taos, NM 87571 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2006 |
Last Update Date | 08/07/2007 |