The holder whose full name is DETATA, GERALD C,come from VINCENTOWN NJ,hold the Physician license(NO.01032214A) which status is Expired Non-Renewable.
| Name | DETATA, GERALD C |
|---|---|
| License Number | 01032214A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | VINCENTOWN |
| State | NJ |