NPI age
16 years
Enumerated 2009-08-23
Across 2956 active specialist/technologist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 | 1012168 | NATA MEMBERSHIP |
| 01 | 2000002577 | BOC CERTIFICATION |
| 01 (TX) | AT4649 | STATE LICENSE |
Part of a multi-provider practice. 22 other active providers share this practice address in NPPES.
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