The holder whose full name is BIRGE JR, KENNETH WAYNE,come from INDIANAPOLIS IN,hold the Physician license(NO.01036096A) which status is Expired Non-Renewable.
Name | BIRGE JR, KENNETH WAYNE |
---|---|
License Number | 01036096A |
License Type | Physician |
License Status | Expired Non-Renewable |
City | INDIANAPOLIS |
State | IN |