The holder whose full name is Lane, Brian Scott,come from Greenwood IN,hold the Preceptor Eligible license(NO.15003883A) which status is Expired.
| Name | Lane, Brian Scott |
|---|---|
| License Number | 15003883A |
| License Type | Preceptor Eligible |
| License Status | Expired |
| City | Greenwood |
| State | IN |