| NPI | 1720513906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRIAN THOMAS HUNTINGTON Resident Physician 208-863-7795 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: IL 209007222) |
| Additional Taxonomies | 273100000X Epilepsy Unit (Licence: IL 209007222) |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2017-04-26 |