| AMA Member: | No |
| Gender: | Male |
| National Provider Identifier (NPI): | 1346388451 |
| License Number: | MD00015616 |
| License State: | WA |
| Medical School: | Creighton Univ Sch Of Med, Omaha Ne 68178 |
| Residency Training: | Scott Medical Ctr, Flexible Or Transitional Year |
| Graduation Year: | 1973 |