Graduated: 2013
NPI: 1053773010
Practice Locations (3)
4255 PHEASANT RIDGE DR NE, SUITE 412
BLAINE, MN 554495066
7637033755
2086 130TH LN NW
Coon Rapids, MN 554487009
2086 130TH LN NW
COON RAPIDS, MN 554487009
Source: CMS National Downloadable File, September 2026.