Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175L00000X | Homeopath |
NPI | 1902390297 |
---|---|
Provider Name | Mamoun Gwary |
First Address | Chantilly, VA 20151-3358 |
Second Address | Chantilly, VA 20151-3358 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2018 |
Last Update Date | 19/06/2018 |