| NPI | 1568238111 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | WESLEY REID MCILWAIN Owner 907-987-4988 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery |
| Enumeration Date | 2023-11-27 |
| Last Update Date | 2023-11-27 |