The holder whose full name is KINCANNON, KURT,come from LAFAYETTE IN,hold the Preceptor Eligible license(NO.15003429A) which status is Expired.
| Name | KINCANNON, KURT |
|---|---|
| License Number | 15003429A |
| License Type | Preceptor Eligible |
| License Status | Expired |
| City | LAFAYETTE |
| State | IN |