The holder whose full name is Bak, Benjamin H,come from Schererville IN,hold the CSR-Physician license(NO.01059230B) which status is Expired.
| Name | Bak, Benjamin H |
|---|---|
| License Number | 01059230B |
| License Type | CSR-Physician |
| License Status | Expired |
| City | Schererville |
| State | IN |