| NPI | 1063631802 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KAREN HALE Business Office Manager 208-762-6836 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2080P0202X Pediatrics, Pediatric Cardiology (Licence: CA A47742) |
| Additional Taxonomies | 2080P0203X Pediatrics, Pediatric Critical Care Medicine (Licence: CA A47742) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2020-08-22 |