| NPI | 1962417840 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA M SCHINDLER Credentialing Coordinator 801-268-6811 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: UT 39454) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2008-04-01 |