| NPI | 1871016048 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL T SNOW President 208-454-2050 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery (Licence: ID O-110) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2022-07-21 |