Individual
STATON OMO-ABU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
14455 PRESTON RD APT 108, DALLAS, TX 75254-8540
(512) 300-1829
Mailing address
14455 PRESTON RD APT 108, DALLAS, TX 75254-8540
(512) 300-1829
Taxonomy
Speciality
Code
Description
License number
State
374700000X
Technician
Primary
—
TX
Other
Enumeration date
10/26/2023
Last updated
10/27/2023
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