| NPI | 1003218348 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | UMA SRIRAM Director Of Fiscal Affairs 815-395-5637 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 1041C0700X Social Worker Clinical |
| 106H00000X Marriage & Family Therapist | |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2016-04-27 |