NPI age
19 years
Enumerated 2006-08-05
Across 16 active internal medicine providers in Idaho.
1 secondary location on file with NPPES.
| Type | Value | Notes |
|---|---|---|
| 01 (CA) | A103302 | MEDICAL BOARD OF CALIFORNIA |
| 01 (ID) | M-8865 | MD STATE LICENSE |
| 01 (WA) | MD00044230 | MD STATE LICENSE |
| 05 (ID) | 807724500 |
Solo or small practice. No other active providers share this practice address in NPPES.
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