| NPI | 1730554734 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WENDELL GIBBY Manager/Owner 801-229-1014 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology Neurology |
| Additional Taxonomies | 207QA0401X Family Medicine Addiction Medicine |
| 208VP0014X Pain Medicine Interventional Pain Medicine | |
| 363AM0700X Physician Assistant Medical | |
| 363LF0000X Nurse Practitioner Family | |
| Enumeration Date | 2015-12-02 |
| Last Update Date | 2015-12-02 |