| NPI | 1033624663 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KELLIE HAWKINS Credentialing Account Manager 210-298-6847 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YS0123X Otolaryngology, Facial Plastic Surgery |
| Enumeration Date | 2017-12-05 |
| Last Update Date | 2017-12-05 |