| NPI | 1093761439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK FREDERICK FRAZIER Director 847-259-8583 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103T00000X Psychologist |
| Additional Taxonomies | 103G00000X Clinical Neuropsychologist |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2020-09-09 |