| NPI | 1225193584 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RETT HANSEN Clinic Coordinator 801-626-3670 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363AM0700X Physician Assistant, Medical (Licence: UT 3762451206) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2012-05-09 |