| NPI | 1386607356 |
|---|---|
| Former Name | WILLIAM BLAKE KALICH |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: IL 085.003749) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WI 1748023) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2018-10-09 |