| NPI | 1952483299 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD DALE BLICKENSTAFF President 208-377-0820 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207NS0135X Dermatology, Procedural Dermatology (Licence: ID M-5274) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2012-01-30 |