| NPI | 1720035843 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANDREW B MOUTON Owner 708-364-0261 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0400X Psychiatry & Neurology, Neurology |
| Additional Taxonomies | 103TC0700X Psychologist, Clinical |
| 207RP1001X Internal Medicine, Pulmonary Disease | |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2012-11-07 |