Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Feb 23, 2007
License(s)
25MP00175900 (NJ), MA053964 ()
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 318 N LANSDOWNE AVE | Lansdowne, PA 19050-1018 | 610-259-3385 |
| MAILING | 1104 S BURNT MILL RD | Voorhees, NJ 08043-2217 | 856-520-1510 |
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