Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | 2016016976 | MO |
NPI | 1023419405 |
---|---|
Provider Name | Arya W Namin |
First Address | Columbia, MO 65212 |
Second Address | Columbia, MO 65212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2014 |
Last Update Date | 20/07/2016 |