| NPI | 1154527372 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT P YOUNG Owner 435-787-0560 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: UT 295172-1205) |
| Additional Taxonomies | 207NI0002X Dermatology, Clinical & Laboratory Dermatological Immunology (Licence: UT 295172-1205) |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: UT 295172-1205) | |
| 207NS0135X Dermatology, Procedural Dermatology (Licence: UT 295172-1205) | |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2022-07-21 |