Graduated: 1990
NPI: 1528114089
Practice Locations (3)
10096 W FAIRVIEW AVE, SUITE 160
BOISE, ID 837045004
6200 N RIVERPOINTE DR, APT E206
Garden City, ID 837141857
6200 N RIVER POINTE DR, APT E206
GARDEN CITY, ID 837141857
Source: CMS National Downloadable File, September 2026.