| NPI | 1922340124 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALITA RUBY Administrateive Services Manager 208-454-8389 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2022-10-13 |