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"MailingAddressStateName": "IL",
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"FirstLinePracticeLocationAddress": "501 KINGS HWY E STE 110",
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"EnumerationDate": "12/10/2010",
"LastUpdateDate": "01/21/2026",
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"NPIDeactivationDate": null,
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"GenderCode": null,
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"AuthorizedOfficialLastName": "STUMP",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}