| Name | Description | Type | Additional information |
|---|---|---|---|
| LicensureEntity | string |
None. |
|
| LicenseNumber | string |
None. |
|
| InitialLicensureDate | date |
None. |
|
| LicenseExpirationDate | date |
None. |
|
| ValidityDate | date |
None. |
|
| Text | string |
None. |