| NPI | 1114972965 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD HARRIS Authorized Representative 708-450-5055 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208800000X Urology |
| Additional Taxonomies | 363A00000X Physician Assistant |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2021-09-20 |