The holder whose full name is Dersam, Michael Daniel,come from Temple TX,hold the Physician license(NO.01054054A) which status is Expired Non-Renewable.
| Name | Dersam, Michael Daniel |
|---|---|
| License Number | 01054054A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | Temple |
| State | TX |