License Number: ME80526Data As Of 10/23/2021
|License Expiration Date||1/31/2023|
|License Original Issue Date||06/14/2000|
|Address of Record||8581 Lakeside Drive|
|PARKLAND, FL 33076|
|Controlled Substance Prescriber (for the Treatment of Chronic Non-malignant Pain)||No|
|Discipline on File||No|
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