| AMA Member: | Yes |
| Gender: | Male |
| National Provider Identifier (NPI): | 1366467185 |
| License Number: | 4301053478 |
| License State: | MI |
| Medical School: | Univ Of Miami Sch Of Med, Miami Fl 33101 |
| Residency Training: | Or Hlth Sci Univ Hosp, Flexible Or Transitional Year |
| Graduation Year: | 1981 |