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 |