NPI age
19 years
Enumerated 2006-06-28
Across 2956 active specialist/technologist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | AT5471 | ATHLETIC TRAINING LICENSE |
| 01 | 069902740 | NATIONAL CERTIFICATION |
Part of a multi-provider practice. 1 other active provider shares this practice address in NPPES.
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