| NPI | 1194190520 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL EDWARD TOPEL Manager 847-922-3253 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TC0700X Psychologist, Clinical (Licence: IL 071.008824) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: IL 085001699) |
| Enumeration Date | 2015-12-10 |
| Last Update Date | 2020-05-05 |