Graduated: 2000
NPI: 1740683796
Practice Locations (3)
SANFORD MEDICAL CENTER FARGO
1245 WASHINGTON AVE
DETROIT LAKES, MN 565013905
2188462000
SANFORD MEDICAL CENTER FARGO
1412 MAIN ST
HAWLEY, MN 56549
2184833564
REVIVE AND THRIVE THERAPY LLC
139 1ST AVE S
PERHAM, MN 565731701
5073606877
Source: CMS National Downloadable File, September 2026.