| NPI | 1578769816 |
|---|---|
| Other Name | JOEY DALE MICKELSON |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WA MD60456946) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IN 01066154A) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2015-12-30 |