| NPI | 1902171895 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL RICHARD HINCKLEY Owner 801-313-1010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: UT 76133041205) |
| Enumeration Date | 2012-03-12 |
| Last Update Date | 2012-03-12 |