Medical school: WASHINGTON UNIVERSITY SCHOOL OF MEDICINE
Graduated: 1992
NPI: 1184601171
Practice Locations (2)
8170 33RD AVE S, MS 21110Q
MINNEAPOLIS, MN 554254516
PO BOX 43 MR, SUITE 10860
MINNEAPOLIS, MN 554400043
Source: CMS National Downloadable File, September 2026.