Graduated: 1996
NPI: 1396878401
Practice Locations (3)
101 S PARK AVE, SUITE 215
IDAHO FALLS, ID 834023626
20852234041
1820 E 17TH ST, SUITE 330
IDAHO FALLS, ID 834046400
3670 S 25TH, SUITE 2
IDAHO FALLS, ID 834044956
Source: CMS National Downloadable File, September 2026.