The holder whose full name is WALTS, TIM,come from MARION IN,hold the Preceptor Eligible license(NO.15000204A) which status is Expired.
| Name | WALTS, TIM |
|---|---|
| License Number | 15000204A |
| License Type | Preceptor Eligible |
| License Status | Expired |
| City | MARION |
| State | IN |