Graduated: 1989
NPI: 1750435178
Practice Locations (3)
614 PORTLAND AVE, SUITE 117
SAINT PAUL, MN 551022279
6512912720
91 SNELLING AVE N, SUITE 230
SAINT PAUL, MN 551046756
91 SNELLING N AVE, SUITE 230
SAINT PAUL, MN 551046756
6512912720
Source: CMS National Downloadable File, September 2026.