Medical school: MEDICAL COLLEGE OF WISCONSIN
Graduated: 2020
NPI: 1104455724
Practice Locations (2)
LIFE CHANGE ASSOCIATES PC
2520 S 5TH AVE
POCATELLO, ID 832041923
2082335433
IDAHO STATE UNIVERSITY
421 MEMORIAL DR
POCATELLO, ID 832014008
2082822434
Source: CMS National Downloadable File, September 2026.