Registry details
Type
Individual
Primary specialty
Physician Assistant, Surgical
Enumerated
Jun 6, 2008
License(s)
C06660 (MD), 10001110A (IN)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 86 THOMAS JOHNSON CT | Frederick, MD 21702-4348 | 301-694-8311 |
| LOCATION | 86 THOMAS JOHNSON CT | Frederick, MD 21702-4348 | 301-694-8311 |
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