| AMA Member: | No |
| Gender: | Male |
| National Provider Identifier (NPI): | 1114140852 |
| License Number: | 18688 |
| License State: | MN |
| Medical School: | Univ Of Mn Med Sch-Minneapolis, Minneapolis Mn 55455 |
| Residency Training: | Hennepin Co Med Ctr, Flexible Or Transitional Year |
| Graduation Year: | 1968 |
| Certifications: | Family Practice |