| AMA Member: | No |
| Gender: | Male |
| National Provider Identifier (NPI): | 1578549812 |
| License Number: | 5101010183 |
| License State: | MI |
| Medical School: | Kirksville College Of Osteopathic Medicine, Kirksville Mo 63501 |
| Residency Training: | Maricopa Med Ctr, Psychiatry |
| Graduation Year: | 1984 |