| 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 |