Medical school: UNIVERSITY OF UTAH SCHOOL OF MEDICINE
Graduated: 1977
NPI: 1316055320
Practice Locations (3)
2065 E 17TH ST, SUITE A
IDAHO FALLS, ID 834048042
2065 E 17TH ST A
IDAHO FALLS, ID 834048042
2085223301
COMMUNITY COUNCIL OF IDAHO, INC.
2100 ALAN ST
IDAHO FALLS, ID 834045801
2085287655
Source: CMS National Downloadable File, September 2026.