| NPI | 1093199754 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LORIN MICKELSEN Resident 801-928-0401 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP1100X Clinic/Center, Podiatric (Licence: KY 00433) |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2015-07-13 |