| 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 |