Facts
- Status
- A
- Credential
- MD
- Type
- Individual
- Enumeration date
- 2013-06-12
- Last updated
- 2022-11-18
Licenses
- License PA
- MT205030
- License TX
- R8303
Location
- Practice location
- 2002 HOLCOMBE BLVD
- City
- HOUSTON TX
- Postal code
- 770304211
- Phone
- 713-791-1414
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.