The holder whose full name is Jensen, James Waldemar,come from Portland OR,hold the Temporary MD Permit license(NO.99002824A) which status is Superceded.
| Name | Jensen, James Waldemar |
|---|---|
| License Number | 99002824A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Portland |
| State | OR |