| AMA Member: | Yes |
| Gender: | Male |
| National Provider Identifier (NPI): | 1033211909 |
| License Number: | 35025862 |
| License State: | OH |
| Medical School: | Oh State Univ Coll Of Med, Columbus Oh 43210 |
| Residency Training: | Comm Hosp Of Springfield, Flexible Or Transitional Year |
| Graduation Year: | 1962 |