| NPI | 1093224818 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN COOKSEY Practice Manager 801-232-6556 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 177611-1205) |
| Enumeration Date | 2017-09-25 |
| Last Update Date | 2020-02-08 |