| NPI | 1316090426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK RANDALL KEANE Member 208-746-3320 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology (Licence: ID M7728) |
| Enumeration Date | 2007-01-19 |
| Last Update Date | 2020-08-22 |