| NPI | 1487011995 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALANA ERICKSON Director 208-315-4141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0900X Dermatology, Dermatopathology (Licence: CA A97902) |
| Enumeration Date | 2016-01-28 |
| Last Update Date | 2016-01-28 |