The holder whose full name is Liepert, Douglas Robert,come from South Bend IN,hold the Temporary MD Permit license(NO.99042125A) which status is Superceded.
| Name | Liepert, Douglas Robert |
|---|---|
| License Number | 99042125A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | South Bend |
| State | IN |