| NPI | 1881174431 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTIN MORONI DAZLEY Organizer 801-916-0829 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207XS0117X Orthopaedic Surgery, Orthopaedic Surgery of the Spine (Licence: WY TL4296) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: WY TL4296) |
| Enumeration Date | 2018-08-14 |
| Last Update Date | 2018-08-14 |