| AMA Member: | Yes |
| Gender: | Male |
| National Provider Identifier (NPI): | 1104817105 |
| License Number: | 34101 |
| License State: | IA |
| Medical School: | Indiana University School Of Medicine, Indianapolis In 46202 |
| Residency Training: | Naval Hosp Pensacola, Family Practice |
| Graduation Year: | 1983 |