Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Jun 8, 2020
License(s)
MA061580 (PA), 50.007059rx (OH)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 8591 CROSSROADS DR | Youngstown, OH 44514-4382 | |
| LOCATION | 8591 CROSSROADS DR | Youngstown, OH 44514-4382 | 330-758-0577 |
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