Graduated: 1988
NPI: 1194777060
Practice Locations (2)
IDAHO UROLOGIC INSTITUTE PA
2855 E MAGIC VIEW DR
MERIDIAN, ID 836426245
2086394900
MERCY HEALTH SYSTEM CORPORATION
1000 MINERAL POINT AVE
JANESVILLE, WI 535482940
6087566000
Source: CMS National Downloadable File, September 2026.