Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH00001293 | WA |
NPI | 1013299478 |
---|---|
Provider Name | Dr. Michael Thomas Breneman |
First Address | Arlington, WA 98223-5924 |
Second Address | Arlington, WA 98223-5924 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2011 |
Last Update Date | 12/09/2011 |