Medical school: RUTGERS NEW JERSEY MEDICAL SCHOOL
Graduated: 1989
NPI: 1033296330
Practice Locations (2)
POCATELLO HEALTH SERVICES LLC
2240 E CTR ST
POCATELLO, ID 832012600
2082332100
POCATELLO HEALTH SERVICES LLC
777 HOSPITAL WAY
POCATELLO, ID 832015175
Source: CMS National Downloadable File, September 2026.