| AMA Member: | No |
| Gender: | Male |
| National Provider Identifier (NPI): | 1871701151 |
| License Number: | 4301033894 |
| License State: | MI |
| Medical School: | Wayne State Univ Sch Of Med, Detroit Mi 48201 |
| Residency Training: | Lafayette Clinic, Psychiatry |
| Graduation Year: | 1973 |
| Certifications: | Psychiatry |