| NPI | 1174187165 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ASHLEY ANNE HAMSTRA Owner 208-277-9704 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology |
| Additional Taxonomies | 207N00000X Dermatology |
| Enumeration Date | 2019-04-25 |
| Last Update Date | 2019-09-06 |