| NPI | 1295781920 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JENNIFER R. LARSON Office Manger 952-403-3399 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2010-05-21 |