Medical school: UNIFORMED SERVICES UHS FE HEBERT SCHOOL OF MED
Graduated: 1990
NPI: 1619940210
Practice Locations (3)
ST MARYS REGIONAL HEALTH CENTER
1027 WASHINGTON AVE
DETROIT LAKES, MN 565013409
2188442300
INNOVIS HEALTH LLC
1702 UNIVERSITY DR S
FARGO, ND 581034940
7013648900
INNOVIS HEALTH LLC
3000 32ND AVE S
FARGO, ND 581036132
7013648000
Source: CMS National Downloadable File, September 2026.