| NPI | 1942623111 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HENRI GODBOLD Owner 248-855-1956 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: MI 4301080800) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301080880) |
| Enumeration Date | 2014-01-24 |
| Last Update Date | 2014-05-15 |