NPI age
20 years
Enumerated 2006-04-03
Across 2956 active specialist/technologist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (PA) | 003978 | STATE LICENSE |
| 01 (TX) | 1795 | STATE LICENSE |
| 01 (IN) | 36001657A | INDIANA PROFESSIONAL LICENSING AGENCY, ATHLETIC TRAINERS BOARD |
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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