ELLIOTT S WISE - Physician Assistant License in Illinois | # 085004456

ELLIOTT S WISE

Business Entity

NOT RENEWED

License Type

Physician Assistant

Description

LICENSED PHYSICIAN ASSISTANT

License Number

085004456

License Status

NOT RENEWED

Business

N

First Name

ELLIOTT

Middle

S

Last Name

WISE

Business Name

ELLIOTT S WISE

Original Issue Date

09/17/2012

Effective Date

09/17/2012

Expiration Date

03/01/2014

State

IL

Ever Disciplined

N

LastModifiedDate

12/23/2015