Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | 2019-01204 | NC |
NPI | 1699038208 |
---|---|
Provider Name | Andrew Egon Hanselman |
First Address | Wake Forest, NC 27587-5745 |
Second Address | Wake Forest, NC 27587-5745 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2012 |
Last Update Date | 29/07/2019 |