| NPI | 1760907133 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CYNTHIA LEE GORDON Member Manager 847-892-7910 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084P0800X Psychiatry & Neurology, Psychiatry |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2023-05-23 |