| NPI | 1629247093 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRETT GERALD BAGLEY Physician Assistant Certified 208-359-2263 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: ID PA-215) |
| Enumeration Date | 2008-02-29 |
| Last Update Date | 2018-06-26 |