| NPI | 1891179610 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEREMY SMUIN Information Specialist 208-232-7862 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: ID MRM-1500) |
| Enumeration Date | 2015-07-10 |
| Last Update Date | 2015-08-14 |