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Licensed Professional Information:
Medical Doctor 4301088555


 

Licensee Detail

 
CONTROLLED SUBSTANCE LIST

City:

Birmingham

State or Province:

Michigan

ZIP or Postal Code:

48009

CS Record Number:

5315046989

CS Status:

Active

CS Expiration Date:

06/30/2023

 

City:

Royal Oak

State or Province:

Michigan

ZIP or Postal Code:

48073

CS Record Number:

5315027796

CS Status:

Lapsed

CS Expiration Date:

06/30/2010

 
 

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