The holder whose full name is BLACK, DANIEL JEROME,come from DES PLAINES IL,hold the Physician license(NO.01016964A) which status is Expired Non-Renewable.
| Name | BLACK, DANIEL JEROME |
|---|---|
| License Number | 01016964A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | DES PLAINES |
| State | IL |