| NPI | 1578896965 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KEVIN GERALD DIETRICH Owner 612-384-3049 |
| Organization Subpart ? | No |
| Primary Taxonomy | 335E00000X Prosthetic/Orthotic Supplier |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2009-09-16 |
| Last Update Date | 2009-09-16 |