The holder whose full name is Johnson, Micheal Brent,come from Coeur D Alene ID,hold the Temporary DO Permit license(NO.99048028A) which status is Superceded.
| Name | Johnson, Micheal Brent |
|---|---|
| License Number | 99048028A |
| License Type | Temporary DO Permit |
| License Status | Superceded |
| City | Coeur D Alene |
| State | ID |