Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | 125.075801 | IL |
NPI | 1093339830 |
---|---|
Provider Name | Daniel Ilya Wolfson |
First Address | Chicago, IL 60612-3806 |
Second Address | Chicago, IL 60612-3806 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/06/2020 |
Last Update Date | 11/07/2020 |