Individual
NATHAN KETCHUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
580 CASPER RD SE, RIO RANCHO, NM 87124-3459
(505) 573-7512
Mailing address
580 CASPER RD SE, RIO RANCHO, NM 87124-3459
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
02/11/2014
Last updated
02/11/2014
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