| AMA Member: | Yes |
| Gender: | Male |
| National Provider Identifier (NPI): | 1831130905 |
| License Number: | 02002326A |
| License State: | IN |
| Medical School: | Univ Of Hlth Sci, Coll Of Osteo Med, Kansas City Mo 64124 |
| Residency Training: | Osteo Med Ctr Of Tx-Unthsc/Tco, Family Medicine |
| Graduation Year: | 1989 |