| AMA Member: | Yes |
| Gender: | Male |
| National Provider Identifier (NPI): | 1972662336 |
| License Number: | 45075 |
| License State: | MA |
| Medical School: | Med Coll Of Ga Sch Of Med, Augusta Ga 30912 |
| Residency Training: | Usaf Sch Aerospace Med, General Preventive Medicine; Wright-Patterson Med Ctr, Flexible Or Transitional Year |
| Graduation Year: | 1975 |