The holder whose full name is Shively, John Levi,come from Lafayette IN,hold the Physician license(NO.01015281A) which status is Expired Non-Renewable.
| Name | Shively, John Levi |
|---|---|
| License Number | 01015281A |
| License Type | Physician |
| License Status | Expired Non-Renewable |
| City | Lafayette |
| State | IN |