Wisconsin
Department of Safety and Professional Services
Head, Henry B
Medicine And Surgery
License number
17995-20
Date granted
07/12/1972
Date expires
10/31/2011
Class
Medicine And Surgery
Status
Expired
wisconsinmedicine.org
ID 35597003
LAST UPDATED 2026-05-14 11:00:15 UTC
LAST UPDATED 2026-05-14 11:00:15 UTC
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