License Number: ME118157

Data As Of 12/5/2023

Profession Medical Doctor
License ME118157
License Status CLEAR/ACTIVE
License Expiration Date 1/31/2026
License Original Issue Date 11/26/2013
Address of Record 1350 S Hickory Street
suite 101
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain) No
Discipline on File Yes
Public Complaint Yes

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