Medical school: NORTHEASTERN OHIO UNIVERSITY COLLEGE OF MEDICINE
Graduated: 1985
NPI: 1932246311
Practice Locations (3)
1111 HWY 10 E
DETROIT LAKES, MN 565014215
3800 56TH AVE S
FARGO, ND 581046706
PO BOX, SUITE 1060
UNIONTOWN, OH 44685
Source: CMS National Downloadable File, September 2026.