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 |