Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | R3126 | TX |
Y | 2084V0102X | Vascular Neurology | R3126 | TX |
NPI | 1033464466 |
---|---|
Provider Name | Dr. Sam Jamshid Laali |
First Address | Grapevine, TX 76051 |
Second Address | Grapevine, TX 76051-3565 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2012 |
Last Update Date | 29/07/2021 |