| NPI | 1891108148 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE ELIAS GOMEZ Chairman 269-262-4229 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: MI 4301089165) |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2014-06-04 |