NPI age
13 years
Enumerated 2013-05-07
Across 28 active psychiatry & neurology providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (WY) | 16721C | WY STATE LIC |
| 01 (MT) | MED-PHYS-COM-LIC-135 | MT STATE LICENSE |
| 05 (PA) | 103243408 | |
| 01 (ID) | O-1419 | ID STATE MED LIC |
Part of a multi-provider practice. 107 other active providers share this practice address in NPPES.
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