The holder whose full name is Van, Ngan T.,come from Granger IN,hold the Temporary MD Permit license(NO.99014114A) which status is Superceded.
| Name | Van, Ngan T. |
|---|---|
| License Number | 99014114A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Granger |
| State | IN |