The holder whose full name is Takele, Tatek K.,come from New Berlin WI,hold the Physician license(NO.01065859A) which status is Expired.
| Name | Takele, Tatek K. |
|---|---|
| License Number | 01065859A |
| License Type | Physician |
| License Status | Expired |
| City | New Berlin |
| State | WI |