NPI age
19 years
Enumerated 2007-02-02
Across 1176 active specialist/technologist, other providers in Texas.
| Type | Value | Notes |
|---|---|---|
| 01 (TX) | 32004747419 | TAXPAYER ID |
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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