Graduated: 2003
NPI: 1669528287
Practice Locations (2)
POCATELLO HEALTH SERVICES LLC
777 HOSPITAL WAY
POCATELLO, ID 832015175
2082392260
PROVIDENCE HEALTH AND SERVICES MT
500 W BROADWAY ST, FL 4
MISSOULA, MT 598024008
4063271940
Source: CMS National Downloadable File, September 2026.