| NPI | 1427138734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW WICKERN Credentialing Specialist 208-734-6091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207KA0200X Allergy & Immunology, Allergy |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2021-01-14 |