The holder whose full name is BAUM, JOHN RUSSELL,come from WINONA LAKE IN,hold the Physician license(NO.01012006A) which status is Expired Non-Renewable.
| Name | BAUM, JOHN RUSSELL |
|---|---|
| License Number | 01012006A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | WINONA LAKE |
| State | IN |