| AMA Member: | Yes |
| Gender: | Male |
| National Provider Identifier (NPI): | 1134169873 |
| License Number: | 3692 |
| License State: | AZ |
| Medical School: | Des Moines Univ, Coll Osteo Med & Surg, Des Moines Ia 50312 |
| Residency Training: | Us Army Environ Hyg Agency, Occupational Medicine |
| Graduation Year: | 1977 |