| NPI | 1376178749 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHRISTOPHER MATHISON Owner 218-233-4267 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2020-03-06 |
| Last Update Date | 2022-10-24 |