| Name | Description | Type | Additional information |
|---|---|---|---|
| LicFirstName | string |
None. |
|
| LicMiddleName | string |
None. |
|
| LicLastName | string |
None. |
|
| licAddress1 | string |
None. |
|
| LicJurisdictionCode | string |
None. |
|
| LicCity | string |
None. |
|
| LIcBirthdate | string |
None. |
|
| LicLicenseNumber | string |
None. |
|
| LicExpirationDate | string |
None. |
|
| LicPostalCode | string |
None. |
|
| LicAddress2 | string |
None. |
|
| ResponseCode | string |
None. |