| NPI | 1285630699 |
|---|---|
| Other Name | JACK R KALLIES |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: WI 155) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: IA 2368) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2013-10-24 |