The holder whose full name is Larva, Mark Allen,come from Grand Rapids MI,hold the Physician Assistant - Prescriptive Authority license(NO.10001256A) which status is Expired.
| Name | Larva, Mark Allen |
|---|---|
| License Number | 10001256A |
| License Type | Physician Assistant - Prescriptive Authority |
| License Status | Expired |
| City | Grand Rapids |
| State | MI |