Graduated: 2019
NPI: 1386284958
Practice Locations (4)
250 NORTHWEST BLVD, SUITE 101
COEUR D ALENE, ID 838142974
2082541881
PO BOX, SUITE 1138
COEUR D ALENE, ID 83816
200 LIPPERT DR W APT, I145
Port Orchard, WA 983662068
200 LIPPERT DR W, APT I145
PORT ORCHARD, WA 983662068
Source: CMS National Downloadable File, September 2026.