| NPI | 1427315654 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | PAMELA LOUISE SHIRLEY Office Manager 402-443-4600 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QS0010X Family Medicine, Sports Medicine (Licence: NE 179) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NE 179) |
| Enumeration Date | 2012-04-12 |
| Last Update Date | 2012-04-12 |