The holder whose full name is LARDIZABAL, JOSE MARQUEZ,come from BLOOMFIELD IN,hold the Physician license(NO.01021661A) which status is Expired Non-Renewable.
Name | LARDIZABAL, JOSE MARQUEZ |
---|---|
License Number | 01021661A |
License Type | Physician |
License Status | Expired Non-Renewable |
City | BLOOMFIELD |
State | IN |