| NPI | 1851799621 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CAITLIN A ST MARK Practice Manager 208-758-0486 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 207XS0106X Orthopaedic Surgery, Hand Surgery |
| 208200000X Plastic Surgery | |
| 2082S0105X Plastic Surgery, Surgery of the Hand | |
| Enumeration Date | 2014-12-10 |
| Last Update Date | 2023-11-01 |