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 |