| NPI | 1245433861 |
|---|---|
| Other Name | IVAN ANTONIO RIVERA |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ACN241) |
| Additional Taxonomies | 208D00000X General Practice (Licence: PR 14883) |
| Enumeration Date | 2007-06-10 |
| Last Update Date | 2017-02-15 |