| NPI | 1184210031 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEREK COLLETTE Authorized Official 801-997-1276 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine |
| Enumeration Date | 2020-12-15 |
| Last Update Date | 2023-12-22 |