The holder whose full name is Gallardo, Rafael L.,come from Terre Haute IN,hold the Temporary MD Permit license(NO.99016698A) which status is Superceded.
| Name | Gallardo, Rafael L. |
|---|---|
| License Number | 99016698A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Terre Haute |
| State | IN |