Graduated: 2019
NPI: 1902443096
Practice Locations (2)
WHITE RIVER HEALTH DISTRICT
1605 GEORGE JACKSON RD
MAUPIN, OR 970379208
5413952911
LEGACY PRIMARY CARE PLLC
4010 N COLLEGE DR, SUITE 1
CHEYENNE, WY 820011960
7015164637
Source: CMS National Downloadable File, September 2026.