| NPI | 1770660185 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSEPH LEAL Owner 406-345-8900 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MT 6419) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MT 76) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-08-22 |