Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | FT629 | KY |
NPI | 1083387252 |
---|---|
Provider Name | Hussain Mustafa Juma Al Lawati |
First Address | Louisville, KY 40202-3840 |
Second Address | Louisville, KY 40202-3840 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2021 |
Last Update Date | 26/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FT629 | KY MEDICAL BOARD (01) | KY |