| NPI | 1083611966 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHELLE LYNN HINES Business Office 801-262-3441 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology |
| Additional Taxonomies | 103T00000X Psychologist |
| 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 0055926) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2022-07-21 |