THE FOLLOWING INFORMATION WAS OBTAINED FROM THE PHYSICIAN REGISTER SECTION OF THE WEBSITE OF THE COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO (WWW.CPSO.ON.CA) AS OF THE DATE AND TIME NOTED BELOW
10/05/25 05:27:38 AM

General Information

Former Name: No Former Name
Medical School: University of Indonesia, 2009
Gender: Man
Languages Spoken: ENGLISH, INDONESIAN

Practice Information

Primary Business Location: Address not Available
Business Email: No Information Available
Phone: No Information Available
Fax: No Information Available

Specialties

No Specialty Reported

Hospital Privileges

No information available

General Information

Former Name: No Former Name
Gender: Man
Languages Spoken: ENGLISH, INDONESIAN
Medical School: University of Indonesia, 2009

Practice Information

Primary Business Location: Address not Available
Business Email: No Information Available
Phone: No Information Available
Fax: No Information Available

Specialties

No Specialty Reported

Hospital Privileges

No information available

Practice Conditions

This physician is inactive (Expired, Resigned, Suspended, Revoked, or Deceased) and is not permitted to practise medicine.
This physician is inactive (Expired, Resigned, Suspended, Revoked, or Deceased) and is not permitted to practise medicine.

Current Tribunal Proceedings

No information available

Past Tribunal Proceedings

No information available

Current Tribunal Proceedings

No information available

Past Tribunal Proceedings

No information available

Training

Medical School: University of Indonesia, 2009

Registration History

DETAILS DATE
Expired: Resigned from membership. Effective: 02 Dec 2021
Terms and conditions amended by Registration Committee. Effective: 17 Apr 2020
First certificate of registration issued: Restricted Certificate Effective: 19 Nov 2018
Arrow_iconTerms and conditions imposed on certificate by: Registration Committee Effective: 19 Nov 2018
DETAILS: Expired: Resigned from membership.
Date: Effective: 02 Dec 2021
DETAILS: Terms and conditions amended by Registration Committee.
Date: Effective: 17 Apr 2020
DETAILS: First certificate of registration issued: Restricted Certificate
Date: Effective: 19 Nov 2018
DETAILS: Terms and conditions imposed on certificate by: Registration Committee
Date: Effective: 19 Nov 2018