| NPI | 1104004928 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TODD L HURT Field Operations Manager 208-455-7057 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) |
| Enumeration Date | 2008-02-04 |
| Last Update Date | 2009-01-28 |