Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 40397 | ID |
NPI | 1003407404 |
---|---|
Provider Name | John Bradford Hunt |
First Address | Boise, ID 83706-2058 |
Second Address | Boise, ID 83706-2058 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2021 |
Last Update Date | 28/01/2021 |