The holder whose full name is Genicoff, Alan,come from Greensburg IN,hold the Temporary MD Permit license(NO.99012162A) which status is Superceded.
| Name | Genicoff, Alan |
|---|---|
| License Number | 99012162A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Greensburg |
| State | IN |