Medical school: UNIVERSITY OF MICHIGAN MEDICAL SCHOOL
Graduated: 1999
NPI: 1568487726
Practice Locations (2)
POCATELLO HEALTH SERVICES LLC
777 HOSPITAL WAY
POCATELLO, ID 832015175
2082342001
HEALTHTEXAS PROVIDER NETWORK
2020 W STATE HWY 114 340, BAYLOR SCOTT AND WHITE
GRAPEVINE, TX 760518650
2148208350
Source: CMS National Downloadable File, September 2026.