| NPI | 1063840288 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRANDON MINER Office Manager 208-525-4888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: ID O-0568) |
| Enumeration Date | 2013-10-25 |
| Last Update Date | 2013-10-25 |