| NPI | 1760459028 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARY ELLEN ARTIOLI Credentialing Specialist 843-234-6946 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Y00000X Otolaryngology |
| Additional Taxonomies | 207YS0123X Otolaryngology Facial Plastic Surgery |
| 207YX0007X Otolaryngology Plastic Surgery within the Head & Neck | |
| 231H00000X Audiologist | |
| 363AM0700X Physician Assistant Medical | |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2022-08-12 |