| NPI | 1356907133 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DAVID JOHN GUMAN Credentialing Coordinate 414-434-0908 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Enumeration Date | 2019-05-16 |
| Last Update Date | 2019-05-16 |