Medical school: UNIVERSITY OF UTAH SCHOOL OF MEDICINE
Graduated: 2025
NPI: 1508657867
Practice Locations (2)
4554 FORESTDALE DR, UNIT C16
PARK CITY, UT 840985998
PO BOX, SUITE 711185
SALT LAKE CITY, UT 84171
Source: CMS National Downloadable File, September 2026.