State Seal
Current as of 12/16/2018 13:19
License Information
License Number0101023297
OccupationMedicine & Surgery
Address Fairfax, VA 22030
Initial License Date 06/11/1973
Expire Date 05/18/2007
License StatusSurrendered
Additional Public Information* Yes

This serves as primary source verification of the credential issued by the Commonwealth of Virginia and meets the requirements of the Joint Commission.

* "Yes" means that there is information the Department must make available to the public pursuant to §54.1-2400.2.G of the Code of Virginia; please note that this may also include proceedings in which a finding of “no violation” was made. For additional information click on the "Yes" link above. "No" means no documents are available.