The holder whose full name is Wildermuth, Michael Brian,come from Lafayette IN,hold the Medical Residency Permit license(NO.11007242A) which status is Expired.
| Name | Wildermuth, Michael Brian |
|---|---|
| License Number | 11007242A |
| License Type | Medical Residency Permit |
| License Status | Expired |
| City | Lafayette |
| State | IN |