| NPI | 1346400744 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LEE SELF President 208-425-7507 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: ID M7844) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2008-06-10 |
| Last Update Date | 2023-03-24 |