The holder whose full name is De Los Rios, Juan Jose Leon,come from Pocatello ID,hold the Limited Scope MD license(NO.99039602A) which status is Expired.
| Name | De Los Rios, Juan Jose Leon |
|---|---|
| License Number | 99039602A |
| License Type | Limited Scope MD |
| License Status | Expired |
| City | Pocatello |
| State | ID |