The holder whose full name is CLARK, EZRA T,come from LAFAYETTE CA,hold the Physician license(NO.01041070A) which status is Expired Non-Renewable.
| Name | CLARK, EZRA T |
|---|---|
| License Number | 01041070A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | LAFAYETTE |
| State | CA |