Graduated: 1999
NPI: 1457426090
Practice Locations (2)
PARK NICOLLET CLINIC
9555 UPLAND LN N
MAPLE GROVE, MN 553694485
9529939900
GROUP HEALTH PLAN INC
4730 CHICAGO AVE S
MINNEAPOLIS, MN 554073515
6123130000
Source: CMS National Downloadable File, September 2026.