Individual
WEST MARINIER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
507 KELLY CT, LOMBARD, IL 60148-3114
(630) 207-0720
Mailing address
507 KELLY CT, LOMBARD, IL 60148-3114
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
1-18-29772
IL
Other
Enumeration date
03/30/2018
Last updated
03/30/2018
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