Medical school: UNIVERSITY OF UTAH SCHOOL OF MEDICINE
Graduated: 2025
NPI: 1053000646
Practice Locations (2)
9056 N MOUNT AIREY DR, ATTN CREDENTIALING
Eagle Mountain, UT 840054605
1055 N 500
PROVO, UT 846043305
Source: CMS National Downloadable File, September 2026.