The holder whose full name is CHIBA, MASARU,come from Lafayette IN,hold the Physician license(NO.01053562A) which status is Expired Non-Renewable.
| Name | CHIBA, MASARU |
|---|---|
| License Number | 01053562A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | Lafayette |
| State | IN |