License Number: DN22940Data As Of 9/24/2023
|License Expiration Date||2/28/2024|
|License Original Issue Date||07/21/2017|
|Address of Record||9070 Kimberly Blvd|
|BOCA RATON, FL 33434|
|Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)||No|
|Discipline on File||No|
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