| NPI | 1528226263 |
|---|---|
| Other Name | TED PARK |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WA PO 60234756) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E4895) |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2015-03-09 |