| NPI | 1083110498 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREG VANICHKACHORN President 406-300-4712 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MT 12202) |
| Additional Taxonomies | 2083X0100X Preventive Medicine, Occupational Medicine (Licence: MT 12202) |
| Enumeration Date | 2018-04-04 |
| Last Update Date | 2018-10-18 |