| NPI | 1891166880 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY CARL WROBEL Member 208-861-2859 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: ID NP-1250A) |
| Enumeration Date | 2015-10-15 |
| Last Update Date | 2020-09-30 |