| NPI | 1205663846 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NICOLE WARNER SHAHA Surgical Assistant 208-716-2350 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical |
| Enumeration Date | 2024-09-17 |
| Last Update Date | 2024-09-17 |