NPI age
19 years
Enumerated 2006-12-29
Across 52 active specialist/technologist, other providers in Idaho.
| Type | Value | Notes |
|---|---|---|
| 01 | 06-158 | AM BOARD OF SURG ASSIST |
| 01 (ID) | 109984 | NBSTSA |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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