RANDAL LEE WRAALSTAD DPM - Podiatrist License in Idaho | # 016004804

RANDAL LEE WRAALSTAD DPM

Business Entity

INACTIVE

License Type

Podiatrist

Description

LICENSED PODIATRIC PHYSICIAN

License Number

016004804

License Status

INACTIVE

Business

N

First Name

RANDAL LEE

Last Name

WRAALSTAD

Suffix

DPM

Business Name

RANDAL LEE WRAALSTAD DPM

Original Issue Date

12/02/1996

Effective Date

02/01/2007

Expiration Date

01/31/2009

State

ID

Ever Disciplined

N

LastModifiedDate

11/14/2008