The holder whose full name is Bloomfield, Nathan WIlliam,come from Fort Wayne IN,hold the Temporary PTA Permit license(NO.99062439A) which status is Superceded.
| Name | Bloomfield, Nathan WIlliam |
|---|---|
| License Number | 99062439A |
| License Type | Temporary PTA Permit |
| License Status | Superceded |
| City | Fort Wayne |
| State | IN |