The holder whose full name is Thupvong, Taratip,come from Valparaiso IN,hold the Physician license(NO.01065564A) which status is Expired Non-Renewable.
| Name | Thupvong, Taratip |
|---|---|
| License Number | 01065564A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | Valparaiso |
| State | IN |