| NPI | 1154549616 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER MARTIN Office Manager 208-552-1406 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: ID M-8270) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2023-03-07 |