NPI age
20 years
Enumerated 2005-09-08
Across 4038 active specialist providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 05 (TX) | 035340102 | |
| 05 (TX) | 172861001 |
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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