| NPI | 1891464905 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHANIE PERSONDEK Member 208-755-6731 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207VB0002X Obstetrics & Gynecology, Bariatric Medicine |
| Enumeration Date | 2021-09-10 |
| Last Update Date | 2025-07-17 |