| NPI | 1972859510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANA V ANGELES Practice Coordinator 847-251-2400 |
| Organization Subpart ? | No |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: MO 1116914) |
| Enumeration Date | 2012-08-01 |
| Last Update Date | 2012-08-01 |