License Number: ME96444Data As Of 2/6/2023
|License Expiration Date||1/31/2024|
|License Original Issue Date||07/31/2006|
|Address of Record||2295 Pasco Street|
|TALLAHASSEE, FL 32310|
|Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)||No|
|Discipline on File||No|
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