Graduated: 2018
NPI: 1073080610
Practice Locations (3)
3040 S FORK BLVD APT, SUITE 2104
Idaho Falls, ID 834021331
1908 JENNIE LEE DR
IDAHO FALLS, ID 834046159
3040 S FORK BLVD, APT 2104
IDAHO FALLS, ID 834021331
Source: CMS National Downloadable File, September 2026.