The holder whose full name is LAPUT, AMADOR JARDIEL,come from LOGANSPORT IN,hold the CSR-Physician license(NO.01041252B) which status is Expired.
| Name | LAPUT, AMADOR JARDIEL |
|---|---|
| License Number | 01041252B |
| License Type | CSR-Physician |
| License Status | Expired |
| City | LOGANSPORT |
| State | IN |