ANDREW CHARLES TISTADT
Idaho PAT-476 Expired
This Idaho license was held by ANDREW CHARLES TISTADT. The license is no longer active. It was granted on 04/03/2006 and expired on 04/22/2006
LICENSE DETAILS
- License Number: PAT-476
- Category: Board Of Medicine
- Status: Expired
- Date Granted: 04/03/2006 (about 19 years ago)
- Expiry Date: 04/22/2006 (about 19 years ago)
LOCATIONS
A Residential
20663 NW ROCKSPRING LANE BEAVERTON OR 97006