The holder whose full name is Spivak, Dana,come from Longmeadow MA,hold the Temporary MD Permit license(NO.99006395A) which status is Superceded.
| Name | Spivak, Dana |
|---|---|
| License Number | 99006395A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Longmeadow |
| State | MA |