| NPI | 1841425022 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEFFREY RUSSELL Owner 517-278-8000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101011799) |
| Additional Taxonomies | 101YP2500X Counselor, Professional (Licence: MI 6401009358) |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2009-09-23 |