| NPI | 1265635346 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CRAIG Z. HALL President 208-523-8844 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID RPA-214) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IN NP-253A) |
| Enumeration Date | 2007-06-07 |
| Last Update Date | 2007-09-13 |