| NPI | 1336571785 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRENTON DALE WALLACE Podiatrist 405-446-8290 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OK 292) |
| Enumeration Date | 2013-08-07 |
| Last Update Date | 2016-06-23 |