Individual
GREGORY PHILIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2035 S 4TH ST, PHILADELPHIA, PA 19148-2550
(312) 914-0611
Mailing address
306 N KENSINGTON AVE, LA GRANGE PARK, IL 60526-1870
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/01/2020
Last updated
05/01/2020
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