| NPI | 1437866654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER MAYNARD BRYANT Owner 208-304-6401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2022-10-28 |
| Last Update Date | 2023-01-11 |