| Certificate Number | 15065 | ||
| Class | Inactive | From June 01, 2020 | |
| Class History | Full | From April 25, 2015 | |
| Grandparented | From April 24, 2015 | ||
| Status | Resigned | From June 01, 2020 | |
| Status History | In good standing | From April 24, 2015 | |
| Restrictions/Disciplines | No | ||
| First Name | Lisa |
| Middle Name | Marie |
| Last Name | Formosa |
| Alternate Name |
| Professional Body Name | Country | Region |
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