The holder whose full name is Fukumoto, Richard Isamu,come from Anaheim CA,hold the Physician license(NO.01018331A) which status is Inactive/Expired.
| Name | Fukumoto, Richard Isamu |
|---|---|
| License Number | 01018331A |
| License Type | Physician |
| License Status | Inactive/Expired |
| City | Anaheim |
| State | CA |