| NPI | 1578229233 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE W CHRISTENSEN Office Manager 801-627-0515 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology |
| Additional Taxonomies | 207NS0135X Dermatology Procedural Dermatology |
| Enumeration Date | 2021-11-16 |
| Last Update Date | 2021-11-16 |