NPI age
14 years
Enumerated 2012-04-18
Across 592 active psychiatry & neurology providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 351484609 | |
| 01 (NE) | 26576 | NEBRASKA MEDICAL LICENSE # |
| 01 (TX) | P1445 | TEXAS MEDICAL BOARD LICENSE # |
Part of a multi-provider practice. 7 other active providers share this practice address in NPPES.
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