| NPI | 1386921294 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN SCOTT OWSLEY Owner 208-467-7546 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: ID M8483) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: ID PA280) |
| Enumeration Date | 2011-11-05 |
| Last Update Date | 2019-12-23 |