The holder whose full name is Blumenthal, Elliot Jay,come from South Bend IN,hold the Physician license(NO.01025560A) which status is Expired Non-Renewable.
| Name | Blumenthal, Elliot Jay |
|---|---|
| License Number | 01025560A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | South Bend |
| State | IN |