The holder whose full name is GOODMAN, DAVID MARK,come from LAFAYETTE IN,hold the Physician license(NO.01034500A) which status is Expired Non-Renewable.
| Name | GOODMAN, DAVID MARK |
|---|---|
| License Number | 01034500A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | LAFAYETTE |
| State | IN |