Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2084N0400X | Neurologist | S1615 | TX |
NPI | 1043578289 |
---|---|
Provider Name | Seyed Pouyan Jalali |
First Address | Dallas, TX 75284-4658 |
Second Address | Temple, TX 76508 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2012 |
Last Update Date | 01/12/2020 |