Graduated: 2019
NPI: 1154983740
Practice Locations (2)
GROUP HEALTH PLAN INC
640 JACKSON ST
SAINT PAUL, MN 551012502
6512544786
SOUTH CAROLINA SPORTS MEDICINE AND ORTHOPAEDIC CENTER
9100 MEDCOM ST
N CHARLESTON, SC 294069167
8435722663
Source: CMS National Downloadable File, September 2026.