Graduated: 1993
NPI: 1174609804
Practice Locations (2)
PARK NICOLLET CLINIC
5320 HYLAND GREENS DR
BLOOMINGTON, MN 554373934
9529932400
PARK NICOLLET CLINIC
4670 PARK NICOLLET AVE SE
PRIOR LAKE, MN 553724119
9529937750
Source: CMS National Downloadable File, September 2026.