| NPI | 1376154039 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANTHONY J RUSSO Delegated Official 406-533-9688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261Q00000X Clinic/Center |
| Additional Taxonomies | 2084N0008X Psychiatry & Neurology Neuromuscular Medicine |
| Enumeration Date | 2020-08-14 |
| Last Update Date | 2023-03-21 |