| NPI | 1023635018 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON MARTIN Psychiatric Nurse Practitioner 208-360-0288 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2020-06-25 |