| NPI | 1366705998 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KERRY DUNGER Executive Director License 314-364-3707 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 207Y00000X Otolaryngology |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2012-06-19 |
| Last Update Date | 2025-04-28 |