Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath | 175L00000X | TX |
NPI | 1134101132 |
---|---|
Provider Name | Randall Matthew Carter |
First Address | Stafford, TX 77477-3029 |
Second Address | Stafford, TX 77477-3029 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 08/07/2007 |