STEFAN BOTHA

FORT DRUM, NY
NPI1811583446
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: TX  PA14092)
Additional Taxonomies363A00000X Physician Assistant
Enumeration Date2020-12-17
Last Update Date2024-06-04
Business Address
STEFAN BOTHA
11050 MOUNT BELVEDERE BLVD
FORT DRUM, NY 13602-5438
Phone number: 315-772-2729
Mailing Address
STEFAN BOTHA
11050 MOUNT BELVEDERE BLVD
FORT DRUM, NY 13602-5438
Phone number: 210-264-4348
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