Individual
PUSPA GAUTAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
745 E 300 S, SALT LAKE CITY, UT 84102-2256
(801) 977-9119
Mailing address
4302 S 900 E, SALT LAKE CITY, UT 84124-2408
Taxonomy
Speciality
Code
Description
License number
State
171R00000X
Interpreter
Primary
—
—
Other
Enumeration date
09/18/2013
Last updated
09/18/2013
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