The holder whose full name is Hicks, Theodore C.,come from Lafayette IN,hold the Physician Assistant - Prescriptive Authority license(NO.10001034A) which status is Active.
| Name | Hicks, Theodore C. |
|---|---|
| License Number | 10001034A |
| License Type | Physician Assistant - Prescriptive Authority |
| License Status | Active |
| City | Lafayette |
| State | IN |