| NPI | 1588731764 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADFORD WAINER Physician 708-484-0042 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2010-06-15 |