Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2019-06-22
- Last updated
- 2022-12-17
Licenses
- License TX
- 35298
- License TX
- 35298
Location
- Practice location
- 1235 KINWEST PKWY
- City
- IRVING TX
- Postal code
- 750633403
- Phone
- 832-715-7860
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.