| NPI | 1053765545 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | A RICHARD MIRANDA CEO 208-420-1319 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: ID M-9799) |
| Additional Taxonomies | 207RH0003X Internal Medicine, Hematology & Oncology (Licence: OR MD151354) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2016-04-20 |