| NPI | 1164493334 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK W PETERSON Owner 208-743-4393 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology |
| Additional Taxonomies | 2085R0204X Radiology, Vascular & Interventional Radiology |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2020-08-22 |