Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Sep 5, 2018
License(s)
022393-01 (NY), 0010-14264 (NC)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | 816 FAIRMEADOW AVE | High Point, NC 27265-2120 | 516-972-5635 |
| LOCATION | 5826 SAMET DR STE 101 | High Point, NC 27265-3661 | 336-905-6435 |
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