License Number: ME35292Data As Of 7/10/2020
|License Expiration Date||1/31/2021|
|License Original Issue Date||10/11/1979|
|Address of Record||3501 CATTLEMEN ROAD|
|SARASOTA, FL 34232|
|Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)||Yes|
|Discipline on File||No|
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