License Number: ME73661Data As Of 6/2/2020
|License Expiration Date||1/31/2019|
|License Original Issue Date||07/21/1997|
|Address of Record||If further information is needed, please contact the Department of Health at (850) 488-0595.|
|Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)||No|
|Discipline on File||Yes|
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