License Number: ME85650Data As Of 6/2/2020
|License Expiration Date||1/31/2021|
|License Original Issue Date||08/02/2002|
|Address of Record||560 Village Blvd #200|
|WEST PALM BEACH, FL 33409|
|Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)||No|
|Discipline on File||Yes|
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