License Number: DN24131Data As Of 12/5/2023
|License Expiration Date||2/28/2024|
|License Original Issue Date||05/29/2019|
|Address of Record||500 Three Islands blvd apt#309|
|HALLANDALE BEACH, FL 33009|
|Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)||No|
|Discipline on File||No|
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