The holder whose full name is WALLING, JOHN R,come from LAFAYETTE IN,hold the Preceptor Eligible license(NO.15001434A) which status is Expired.
| Name | WALLING, JOHN R |
|---|---|
| License Number | 15001434A |
| License Type | Preceptor Eligible |
| License Status | Expired |
| City | LAFAYETTE |
| State | IN |