The holder whose full name is Wibisono, Bernadeta Leegan,come from Munster IN,hold the Temporary MD Permit license(NO.99062044A) which status is Superceded.
| Name | Wibisono, Bernadeta Leegan |
|---|---|
| License Number | 99062044A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Munster |
| State | IN |