The holder whose full name is Gumbert, Jack Lee,come from FORT WAYNE IN,hold the Physician license(NO.01019653A) which status is Expired Non-Renewable.
| Name | Gumbert, Jack Lee |
|---|---|
| License Number | 01019653A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | FORT WAYNE |
| State | IN |