The holder whose full name is DETRISAC, DAVID A,come from EAST LANSING MI,hold the Physician license(NO.01035504A) which status is Expired Non-Renewable.
| Name | DETRISAC, DAVID A |
|---|---|
| License Number | 01035504A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | EAST LANSING |
| State | MI |