Indiana
Professional Licensing Agency
Gily N. Martinez
Radiology Provisional Permit
License number
XP500548
Date granted
03/10/2005
Date expires
12/31/2007
Class
Radiology Provisional Permit
Status
Expired Non-Renewable
Address
Fort Wayne IN 468071748
indianalicensing.org
ID 8490919
LAST UPDATED 2026-06-16 12:53:47 UTC
LAST UPDATED 2026-06-16 12:53:47 UTC
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