The holder whose full name is Brigham, Randall Bruce,come from Lafayette IN,hold the Preceptor Eligible license(NO.15003934A) which status is Expired.
| Name | Brigham, Randall Bruce |
|---|---|
| License Number | 15003934A |
| License Type | Preceptor Eligible |
| License Status | Expired |
| City | Lafayette |
| State | IN |