The holder whose full name is Diaz, David,come from Carmel IN,hold the Temporary MD Permit license(NO.99022364A) which status is Superceded.
| Name | Diaz, David |
|---|---|
| License Number | 99022364A |
| License Type | Temporary MD Permit |
| License Status | Superceded |
| City | Carmel |
| State | IN |