| AMA Member: | No |
| Gender: | Male |
| National Provider Identifier (NPI): | 1902801582 |
| License Number: | OS 0004971-L |
| License State: | PA |
| Medical School: | Philadelphia Coll Of Osteopathic Medicine, Philadelphia Pa 19131 |
| Residency Training: | Geisinger Med Ctr, General Surgery |
| Graduation Year: | 1981 |