| NPI | 1467410977 |
|---|---|
| Other Name | SAMUEL ALAN MICKELSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207YS0012X (Licence: GA 041173) |
| Additional Taxonomies | 207Y00000X Otolaryngology (Licence: GA 041173) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2008-05-23 |