| NPI | 1932532686 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JASON P RICHARDS Owner 208-233-8344 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XX0005X Orthopaedic Surgery, Sports Medicine (Licence: ID M12138) |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2013-08-16 |