| AMA Member: | No |
| Gender: | Male |
| National Provider Identifier (NPI): | 1720176035 |
| License Number: | 0650580A |
| License State: | IN |
| Medical School: | Univ Auto De Guadalajara, Fac De Med, Guadalajara, Jalisco, Mexico |
| Residency Training: | Mem Univ Newfdlnd Fac Med, Family Medicine |
| Graduation Year: | 1973 |
| Certifications: | Family Practice |