| NPI | 1003088782 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN L PETERSON CEO 208-525-8448 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2008-04-02 |
| Last Update Date | 2010-08-12 |