| NPI | 1225548571 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN BROWN Credentialing Specialist 801-673-7661 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery |
| Enumeration Date | 2017-09-30 |
| Last Update Date | 2017-09-30 |