| NPI | 1891487997 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN RUDOLPH Owner 208-503-3113 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine |
| Enumeration Date | 2023-05-25 |
| Last Update Date | 2024-01-02 |