NPI age
19 years
Enumerated 2007-02-07
Across 38 active pathology providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (IN) | 01061116A | STATE LICENSE |
| 01 (TX) | 524557 | POSTGRAD TRAINING PERMIT |
Solo or small practice. No other active providers share this practice address in NPPES. This provider is listed as a sole proprietor.
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