The holder whose full name is Dvorak, Derrick William,come from Fort Wayne IN,hold the Temporary MD Permit license(NO.99042489A) which status is Superceded.
| Name | Dvorak, Derrick William |
|---|---|
| License Number | 99042489A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Fort Wayne |
| State | IN |