NPI age
19 years
Enumerated 2006-08-25
Across 245 active psychiatry & neurology providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 (IL) | 1013024827 | NPI NUMBER |
| 01 (IL) | 209004763 | LICENSE |
Solo or small practice. No other active providers share this practice address in NPPES.
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