Graduated: 2020
NPI: 1073119780
Practice Locations (2)
SNAKE RIVER DERMATOLOGY, PA
2101 N WHITLEY DR
FRUITLAND, ID 836192132
2084525999
SNAKE RIVER DERMATOLOGY, PA
11211 W HERCULES DR
STAR, ID 836695074
2082864254
Source: CMS National Downloadable File, September 2026.