Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 58.032292 | OH |
NPI | 1578144515 |
---|---|
Provider Name | Avi Shaw |
First Address | Scottsdale, AZ 85251-5715 |
Second Address | Boardman, OH 44512-6725 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2021 |
Last Update Date | 28/06/2021 |