170300000X
St Cloud, MN
Specialty
170300000X
Credential
MS, LCGC
NPI
1063265031
1900 Centracare Cir, St Cloud, MN 56303
(320) 229-4964Confirm current license and practice information on the official CMS NPI registry.
View NPI RecordThis surgeon specializes in 170300000x procedures performed in an outpatient ambulatory surgical setting.
NUCC Taxonomy: 170300000X