The holder whose full name is Shukla, Abhijit Tanmanishanker,come from Fort Wayne IN,hold the Temporary MD Permit license(NO.99017771A) which status is Superceded.
| Name | Shukla, Abhijit Tanmanishanker |
|---|---|
| License Number | 99017771A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Fort Wayne |
| State | IN |