Medical school: TEXAS TECH UNIVERSITY HEALTH SCIENCE CENTER SCHOOL OF MEDICINE
Graduated: 1985
NPI: 1952795528
Practice Locations (2)
PO BOX, SUITE 190930
Boise, ID 837190930
PO BOX, SUITE 190930
BOISE, ID 83719
Source: CMS National Downloadable File, September 2026.