MIA DIANE GROTH - Respiratory Care Practitioner License in Idaho | # 194003812

MIA DIANE GROTH

Business Entity

NOT RENEWED

License Type

Respiratory Care Practitioner

Description

RESPIRATORY CARE PRACTITIONER

License Number

194003812

License Status

NOT RENEWED

Business

N

First Name

MIA

Middle

DIANE

Last Name

GROTH

Business Name

MIA DIANE GROTH

Original Issue Date

11/22/1999

Effective Date

12/03/2001

Expiration Date

10/31/2001

State

ID

Ever Disciplined

N

LastModifiedDate

09/11/2005