Graduated: 2009
NPI: 1992149975
Practice Locations (2)
PARK NICOLLET CLINIC
5320 HYLAND GREENS DR
BLOOMINGTON, MN 554373934
9529932400
PARK NICOLLET CLINIC
15800 95TH AVE N
MAPLE GROVE, MN 553694400
9529931440
Source: CMS National Downloadable File, September 2026.