Medical school: UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE
Graduated: 2000
NPI: 1831158781
Practice Locations (3)
1540 S LAKE ST
FOREST LAKE, MN 550252628
2925 CHICAGO AVE MAIL STATION
MINNEAPOLIS, MN 554400043
PO BOX 43 MR, SUITE 10860
MINNEAPOLIS, MN 554400043
Source: CMS National Downloadable File, September 2026.