NPI age
15 years
Enumerated 2010-06-03
Across 3028 active surgery providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | Q6860 | TX STATE LICENSE |
| 01 (TX) | BP2-0041560 | PHYSICIAN IN TRAINING LICENSE |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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