| NPI | 1568766566 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY EVANS Billing Supervisor 208-323-9130 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103G00000X Clinical Neuropsychologist (Licence: ID PSY-202444) |
| Enumeration Date | 2011-01-05 |
| Last Update Date | 2011-01-05 |