The holder whose full name is Lee, Bartolome C,come from Syracuse NY,hold the Temporary MD Permit license(NO.99004050A) which status is Superceded.
| Name | Lee, Bartolome C |
|---|---|
| License Number | 99004050A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Syracuse |
| State | NY |