| AMA Member: | Yes |
| Gender: | Male |
| National Provider Identifier (NPI): | 1114010014 |
| License Number: | 14628 |
| License State: | AZ |
| Medical School: | Oh State Univ Coll Of Med, Columbus Oh 43210 |
| Residency Training: | C T Hayden Vet Affairs M C, General Surgery |
| Graduation Year: | 1982 |