Wisconsin
Department of Safety and Professional Services
FORS, TAIT D
Medicine And Surgery
License number
49453-20
Date granted
07/03/2006
Date expires
10/31/2015
Class
Medicine And Surgery
Status
Active
wisconsinmedicine.org
ID 12795332
LAST UPDATED 2026-04-15 06:41:23 UTC
LAST UPDATED 2026-04-15 06:41:23 UTC
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