Medical school: MEDICAL COLLEGE OF WISCONSIN
Graduated: 1997
NPI: 1679545453
Practice Locations (2)
PARK NICOLLET CLINIC
5320 HYLAND GREENS DR
BLOOMINGTON, MN 554373934
9529932400
PARK NICOLLET CLINIC
6500 EXCELSIOR BLVD
ST LOUIS PARK, MN 554264702
9529933123
Source: CMS National Downloadable File, September 2026.