Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 4301114557 | MI |
NPI | 1003307968 |
---|---|
Provider Name | Youssef Daklallah |
First Address | Royal Oak, MI 48073-6712 |
Second Address | Royal Oak, MI 48073-6712 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2018 |
Last Update Date | 25/05/2018 |