Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | 4301094550 | MI |
NPI | 1609005214 |
---|---|
Provider Name | Wendy M Gould |
First Address | Detroit, MI 48202-3450 |
Second Address | Detroit, MI 48202-3450 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2009 |
Last Update Date | 06/07/2009 |