NPI age
10 years
Enumerated 2015-07-24
Across 83 active special hospital providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 | 41090051 | ECFMG IDENTIFICATION |
| 01 (TX) | Q2804 | TEXAS MEDICAL LICENSCE |
| 01 | CAMD-0071-2031 | CANADIAN MINC: |
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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