|
|
| DOCUMENT |
DETAIL |
EXPIRATION |
| National Board of Medical Examiners |
Certificate 84740, issued 1965 |
|
| American Board of Psychiatry and Neurology (Psychiatry) |
Certificate 12001, issued 1972 |
|
| Medicaid |
UPIN C59768 |
|
| Medicaid Provider |
Service Number 0827207 |
|
| Medicare |
Number PU460906 |
|
|