| AMA Member: | Yes |
| Gender: | Male |
| National Provider Identifier (NPI): | 1366400475 |
| License Number: | 5101007720 |
| License State: | MI |
| Medical School: | Kirksville College Of Osteopathic Medicine, Kirksville Mo 63501 |
| Residency Training: | Mi State Univ Clinical Ctr, Psychiatry |
| Graduation Year: | 1979 |
| Certifications: | Psychiatry |