The holder whose full name is Bloom, Carmela T.,come from Fort Wayne IN,hold the Radiology Student Permit - Dental Radiography license(NO.XS001193) which status is Superceded.
| Name | Bloom, Carmela T. |
|---|---|
| License Number | XS001193 |
| License Type | Radiology Student Permit - Dental Radiography |
| License Status | Superceded |
| City | Fort Wayne |
| State | IN |