| NPI | 1487602298 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MATTHEW BRYAN FOWLER President 208-367-6416 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: N/A) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2022-01-14 |