| NPI | 1083109524 |
|---|---|
| Former Legal Business Name | SHIRAZ P. TATA |
| Entity Type | Organization |
| Authorized Contact | SHIRAZ P TATA Licensed Clinical Psychologist 815-519-2949 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.04963) |
| Enumeration Date | 2018-06-27 |
| Last Update Date | 2018-08-01 |