License Number: DN22768Data As Of 1/23/2020
|License Expiration Date||2/28/2020|
|License Original Issue Date||06/23/2017|
|Address of Record||2716 W Atlantic Blvd|
|POMPANO BEACH, FL 33069|
|Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)||No|
|Discipline on File||No|
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