| NPI | 1467819060 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER NELSON Office Manager 801-507-3513 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: UT 9619004-1206) |
| Enumeration Date | 2016-01-27 |
| Last Update Date | 2016-01-27 |