| NPI | 1326274507 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN HAROLD LARSEN Physician 435-753-1171 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: UT 175141-1205) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2009-06-02 |