| AMA Member: | Yes |
| Gender: | Male |
| National Provider Identifier (NPI): | 1710092457 |
| License Number: | R1G23 |
| License State: | MO |
| Medical School: | Oh State Univ Coll Of Med, Columbus Oh 43210 |
| Residency Training: | Miami Valley Hosp, Flexible Or Transitional Year |
| Graduation Year: | 1960 |
| Certifications: | Family Practice |