| NPI | 1700122595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MICHAEL THOMAS WAGNER President 847-987-5450 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry (Licence: IL 042619749) |
| Enumeration Date | 2012-12-24 |
| Last Update Date | 2022-09-26 |