| NPI | 1003584475 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RYAN EDGAR GEGG Owner/Physician 810-610-3313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery |
| Additional Taxonomies | 207K00000X Allergy & Immunology |
| 207Y00000X Otolaryngology | |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2022-07-27 |