Individual
ITORO COSMAS ETIM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
13601 PRESTON RD STE 210W, DALLAS, TX 75240-4986
(972) 702-0300
Mailing address
13601 PRESTON RD STE 210W, DALLAS, TX 75240-4986
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
1021444
TX
Other
Enumeration date
03/09/2021
Last updated
03/09/2021
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