| NPI | 1336362532 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | J GWENDOLYN GORDON Md 248-424-8888 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MI JG023085) |
| Additional Taxonomies | 174400000X Specialist |
| 174400000X Specialist (Licence: MI EC066609) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2009-03-06 |