Medical school: UNIVERSITY OF UTAH SCHOOL OF MEDICINE
Graduated: 1995
NPI: 1285642322
Practice Locations (2)
COMMUNITY COUNCIL OF IDAHO, INC.
2100 ALAN ST
IDAHO FALLS, ID 834045801
2085287655
298 1ST ST
IDAHO FALLS, ID 834013966
2085292544
Source: CMS National Downloadable File, September 2026.