Medical school: OREGON HEALTH SCIENCES UNIVERSITY SCHOOL OF MEDICINE
Graduated: 1964
NPI: 1588734537
Practice Locations (2)
1055 N 300, SUITE 204
PROVO, UT 846043374
1055 N 300 W, SUITE 204
PROVO, UT 846043374
8013577373
Source: CMS National Downloadable File, September 2026.