AMA Member: | Yes |
Gender: | Male |
National Provider Identifier (NPI): | 1497771745 |
License Number: | 01056546A |
License State: | IN |
Medical School: | Univ Airlangga, Fac Of Med, Surabaya, Jawa Timur, Indonesia |
Residency Training: | Western Mo Mntl Hlth Ctr, Psychiatry |
Graduation Year: | 1962 |
Certifications: | Psychiatry |