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License Number: ME93087

Data As Of 6/25/2024

Profession Medical Doctor
License ME93087
License Status CLEAR/Active
Qualifications Dispensing Practitioner
License Expiration Date 1/31/2025
License Original Issue Date 04/16/2005
Address of Record 1611 N.W. 12TH AVE
ECC
MIAMI, FL 33136
Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain) Yes
Discipline on File No
Public Complaint Yes

The information on this page is a secure, primary source for license verification provided by the Florida Department of Health, Division of Medical Quality Assurance. This website is maintained by Division staff and is updated immediately upon a change to our licensing and enforcement database.