| NPI | 1639749534 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GRANT DRAKE Owner/Provider 208-761-3080 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2081P2900X Physical Medicine & Rehabilitation Pain Medicine |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2021-07-01 |