| NPI | 1417054693 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN CHRISTIAN NOWIERSKI Owner 208-939-3197 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID M-7050) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2015-01-05 |