| NPI | 1831196872 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAWN M. BRAINARD Medical Practice Administrator 757-345-3907 |
| Organization Subpart ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101052740) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101048000) |
| Enumeration Date | 2005-07-06 |
| Last Update Date | 2023-03-07 |