| NPI | 1245646041 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA MARIE HAMILTON Physician Assistant 406-403-4798 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: MT 574) |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2020-06-18 |