The holder whose full name is Wickham, Elise M.,come from Eaton IN,hold the Radiology Student Permit - Dental Radiography license(NO.XS004025) which status is Superceded.
| Name | Wickham, Elise M. |
|---|---|
| License Number | XS004025 |
| License Type | Radiology Student Permit - Dental Radiography |
| License Status | Superceded |
| City | Eaton |
| State | IN |