| NPI | 1639587496 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREG J GAVIN Network Administrator 318-212-8780 |
| Organization Subpart ? | No |
| Primary Taxonomy | 2084N0402X Psychiatry & Neurology, Neurology with Special Qualifications in Child Neurology |
| Enumeration Date | 2014-07-24 |
| Last Update Date | 2014-07-24 |