The holder whose full name is Lutz, Mark Wade,come from Indianapolis IN,hold the Physician Assistant - Prescriptive Authority license(NO.10000862A) which status is Active.
| Name | Lutz, Mark Wade |
|---|---|
| License Number | 10000862A |
| License Type | Physician Assistant - Prescriptive Authority |
| License Status | Active |
| City | Indianapolis |
| State | IN |