Registry details
Type
Individual
Primary specialty
Physician Assistant
Enumerated
Jul 16, 2006
License(s)
1876 (MA), MA057997 (PA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 14890 | Albany, NY 12212-4890 | 518-525-5634 |
| LOCATION | 5 PALISADES DR STE 100 | Albany, NY 12205-6433 | 518-438-4496 |
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