The holder whose full name is El Samra, Ahmad Ismail,come from Lafayette IN,hold the CSR-Physician license(NO.01069966B) which status is Active.
| Name | El Samra, Ahmad Ismail |
|---|---|
| License Number | 01069966B |
| License Type | CSR-Physician |
| License Status | Active |
| City | Lafayette |
| State | IN |