License Number: DN20000Data As Of 7/10/2020
|License Expiration Date||2/28/2022|
|License Original Issue Date||11/05/2012|
|Address of Record||1688 Meridian Ave|
|MIAMI BEACH, FL 33139|
|Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)||No|
|Discipline on File||No|
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