Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 9376 | TX |
NPI | 1407105190 |
---|---|
Provider Name | Dr. Brian S. Stanton |
First Address | Cypress, TX 77429-4261 |
Second Address | Katy, TX 77450-2244 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2012 |
Last Update Date | 10/09/2012 |