License holder summary

PRACTICING UNDER FEDERAL REGULATION is a Physician - Physician & Surgeon licensed to practice in Utah. The address on file for PRACTICING UNDER FEDERAL REGULATION is SALT LAKE CITY, UT 84111. This licensed professional license is current. The license was granted 04/05/2010 and expires on 01/31/2099.

Utah

Division of Occupational and Professional Licensing

PRACTICING UNDER FEDERAL REGULATION
Physician - Physician & Surgeon
License number
7643919-1205
Date granted
04/05/2010
Date expires
01/31/2099
Class
Physician - Physician & Surgeon
Status
Active
Address
SALT LAKE CITY, UT 84111
utahlicensing.org
ID 29932175
LAST UPDATED 2026-04-23 12:46:30 UTC

This website is unaffiliated with the Division of Occupational and Professional Licensing. Please verify all information directly with the relevant official government authority.

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