The holder whose full name is Johnson, Nathan Samuel,come from Indianapolis IN,hold the Medical Residency Permit license(NO.11016236A) which status is Superceded.
| Name | Johnson, Nathan Samuel |
|---|---|
| License Number | 11016236A |
| License Type | Medical Residency Permit |
| License Status | Superceded |
| City | Indianapolis |
| State | IN |