Medical school: UNIVERSITY OF MINNESOTA MEDICAL SCHOOL
Graduated: 1995
Also: GENERAL SURGERY
NPI: 1154355311
Practice Locations (2)
PROVIDENCE MEDICAL FOUNDATION
1162 MONTGOMERY DR, SUITE 200
SANTA ROSA, CA 954054802
7078904100
INNOVIS HEALTH LLC
3000 32ND AVE S
FARGO, ND 581036132
7013648000
Source: CMS National Downloadable File, September 2026.