The holder whose full name is Bak, Benjamin H,come from Irving TX,hold the Temporary MD Permit license(NO.99012705A) which status is Superceded.
| Name | Bak, Benjamin H |
|---|---|
| License Number | 99012705A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Irving |
| State | TX |