| NPI | 1689848392 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN L MOHR Owner 612-798-0170 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MN 631) |
| Additional Taxonomies | 213E00000X Podiatrist |
| 335E00000X Prosthetic/Orthotic Supplier (Licence: MN 631) | |
| Enumeration Date | 2008-04-15 |
| Last Update Date | 2024-11-21 |