| NPI | 1497816342 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLINT JAMES CORNELL Owner 989-773-3789 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601003457) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2011-11-14 |