The holder whose full name is Fey, Derek Allan,come from South Bend IN,hold the Student Temp RCP license(NO.99055168A) which status is Expired.
| Name | Fey, Derek Allan |
|---|---|
| License Number | 99055168A |
| License Type | Student Temp RCP |
| License Status | Expired |
| City | South Bend |
| State | IN |