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Individual
MARK BOOTH
Active
Individual
MARK BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
019393
NY
Other
Enumeration date
12/21/2015
Last updated
09/12/2016
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