| NPI | 1891347399 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DANIYAH ALI ELAGI Resident 708-654-9177 |
| Organization Subpart ? | No |
| Primary Taxonomy | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2019-07-15 |
| Last Update Date | 2019-07-15 |