| AMA Member: | No |
| Gender: | Male |
| National Provider Identifier (NPI): | 1124168760 |
| License Number: | G59820 |
| License State: | CA |
| Medical School: | George Washington Univ Sch Of Med & Hlth Sci, Washington Dc 20037 |
| Residency Training: | San Joaquin Gen Hosp, Flexible Or Transitional Year |
| Graduation Year: | 1984 |