Individual
BRYAN MOLES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6157 N KENMORE, APT #4S, CHICAGO, IL 60660
(312) 404-8401
Mailing address
6157 N KENMORE APT #4S, CHICAGO, IL 60660
(312) 404-8401
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
IL
Other
Enumeration date
08/03/2016
Last updated
08/03/2016
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