| NPI | 1417513532 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT E RUST Provider 208-290-3567 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine Addiction Medicine |
| Additional Taxonomies | 101YP2500X Counselor Professional |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2019-05-14 |