The holder whose full name is Yacoub, Basem A.,come from Gary IN,hold the CSR-Physician license(NO.01041730B) which status is Expired.
| Name | Yacoub, Basem A. |
|---|---|
| License Number | 01041730B |
| License Type | CSR-Physician |
| License Status | Expired |
| City | Gary |
| State | IN |