| NPI | 1912915828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PHILIP EDWIN SHAPIRO President 208-630-2666 |
| Organization Subpart ? | No |
| Primary Taxonomy | 291U00000X Clinical Medical Laboratory (Licence: CT CL0562) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: CT 029159) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2013-02-25 |