Medical school: UNIVERSITY OF ILLINOIS COLLEGE OF MED (CHI/PEOR/ROCK/CHM-URB)
Graduated: 2021
NPI: 1841871241
Practice Locations (1)
PRAIRIE RIDGE HEALTH INC
1515 PARK AVE
COLUMBUS, WI 539251618
9206232200
Source: CMS National Downloadable File, September 2026.