Graduated: 2021
NPI: 1639756430
Practice Locations (2)
UNIVERSITY OF UTAH ADULT SERVICES
50 N MEDICAL DR
SALT LAKE CITY, UT 841320100
8015856387
EASTERN SHOSHONE TRIBE
PO BOX, SUITE 128
FORT WASHAKIE, WY 825140128
3073327300
Source: CMS National Downloadable File, September 2026.