NPI age
20 years
Enumerated 2005-07-27
Across 4038 active specialist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 | B0097102 | DPS |
| 01 (TX) | H7913 | STATE LIC |
| 05 (TX) | 100216403 |
Part of a multi-provider practice. 10 other active providers share this practice address in NPPES.
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