The holder whose full name is Hickok, Richard E.,come from Bloomington IN,hold the Radiology Provisional Permit - Cardiac Catheterization license(NO.XP502304) which status is Superceded.
| Name | Hickok, Richard E. |
|---|---|
| License Number | XP502304 |
| License Type | Radiology Provisional Permit - Cardiac Catheterization |
| License Status | Superceded |
| City | Bloomington |
| State | IN |