Graduated: 2012
NPI: 1275968646
Practice Locations (2)
GRAND ITASCA CLINIC AND HOSPITAL
111 SE 3RD ST
GRAND RAPIDS, MN 557443663
2183263401
GRAND ITASCA CLINIC AND HOSPITAL
1601 GOLF COURSE RD
GRAND RAPIDS, MN 557448648
2183263401
Source: CMS National Downloadable File, September 2026.