NPI | 1619365707 |
---|---|
Entity Type | Organization |
Authorized Contact | JARON BRENT SIMONSON Manager 208-406-4738 |
Organization Subpart ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: ID PA994) |
Enumeration Date | 2014-12-26 |
Last Update Date | 2014-12-26 |