| NPI | 1609484492 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIANE WILLIAMS Credentialing Consultant 570-801-1847 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207YX0905X Otolaryngology, Otolaryngology/Facial Plastic Surgery |
| Enumeration Date | 2020-07-17 |
| Last Update Date | 2021-01-12 |