Graduated: 2019
NPI: 1972061059
Practice Locations (3)
330 SHOUP AVE, SUITE 313
IDAHO FALLS, ID 834023605
330 SHOUP AVE, SUITE 313
IDAHO FALLS, ID 834023650
9862940262
2055 N COUGAR WAY
MERIDIAN, ID 836463799
Source: CMS National Downloadable File, September 2026.