Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | NC |
NPI | 1063540599 |
---|---|
Provider Name | Dr. Peter John Michaelson |
First Address | Wilmington, NC 28409-2220 |
Second Address | Wilmington, NC 28401-6600 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2007 |
Last Update Date | 08/07/2007 |