The holder whose full name is Ghosh, Jody Pavlinko,come from West Lafayette IN,hold the Temporary MD Permit license(NO.99017509A) which status is Superceded.
| Name | Ghosh, Jody Pavlinko |
|---|---|
| License Number | 99017509A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | West Lafayette |
| State | IN |