The holder whose full name is Johnson, Tatum Simon,come from El Segundo CA,hold the Physician license(NO.01064246A) which status is Expired Non-Renewable.
| Name | Johnson, Tatum Simon |
|---|---|
| License Number | 01064246A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | El Segundo |
| State | CA |