| NPI | 1437372794 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VICTORIA MOSTOV Practice Administrator 847-884-8884 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: IL 036-075471) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2020-08-22 |