Idaho
Division of Occupational and Professional Licenses
Dr. DANIEL SUSANTO
Board Of Medicine
License number
M-12378
Date granted
03/12/2014
Date expires
06/30/2017
Class
Board Of Medicine
Status
Renewed
Address
RADIA INC. P.S. ATTN: Credentialing Lynnwood WA 98036
idaholicensing.com
ID 48360871
LAST UPDATED 2024-04-12 05:12:28 UTC
LAST UPDATED 2024-04-12 05:12:28 UTC
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