Individual
MR. KEITA SHIMADA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MK, LAT, ATC
Contact information
Practice address
1910 UNIVERSITY DR # MS 1020, BOISE, ID 83725-0001
(208) 407-6526
Mailing address
1910 UNIVERSITY DR # MS 1020, BOISE, ID 83725-0001
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
AT-334
ID
Other
Enumeration date
08/05/2014
Last updated
08/05/2014
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