| NPI | 1710307061 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARK WILHELM Owner 651-227-2427 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier |
| Enumeration Date | 2014-04-24 |
| Last Update Date | 2014-06-09 |