Medical school: UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Graduated: 1991
NPI: 1245293000
Practice Locations (1)
PARK NICOLLET CLINIC
3931 LOUISIANA AVE S
ST LOUIS PARK, MN 554265000
9529931990
Source: CMS National Downloadable File, September 2026.