| NPI | 1518705888 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BENJAMIN CARLSON Member 385-377-3833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2024-07-19 |
| Last Update Date | 2024-11-08 |