Graduated: 2021
NPI: 1508529694
Practice Locations (2)
ST LUKES CLINIC LLC
801 POLE LINE RD W
TWIN FALLS, ID 833015810
2088141000
EL PASO COUNTY HOSPITAL DISTRICT
4815 ALAMEDA AVE
EL PASO, TX 799052705
9155217902
Source: CMS National Downloadable File, September 2026.