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Licensed Professional Information:
Medical Doctor 4301071818


 

Licensee Detail

 
CONTROLLED SUBSTANCE LIST

City:

Grand Rapids

State or Province:

Michigan

ZIP or Postal Code:

49503

CS Record Number:

5315123582

CS Status:

Lapsed

CS Expiration Date:

06/30/2002

 

City:

Troy

State or Province:

Michigan

ZIP or Postal Code:

48084

CS Record Number:

5315011878

CS Status:

Active

CS Expiration Date:

08/21/2027

 
 

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