The holder whose full name is Stout, Blain E.,come from Greenwood IN,hold the Radiology Student Permit - Radiography license(NO.XS001031) which status is Superceded.
| Name | Stout, Blain E. |
|---|---|
| License Number | XS001031 |
| License Type | Radiology Student Permit - Radiography |
| License Status | Superceded |
| City | Greenwood |
| State | IN |