| NPI | 1477651743 |
|---|---|
| Former Name | CATHRYN A SALLA |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 3997-23) |
| Additional Taxonomies | 363AS0400X Physician Assistant, Surgical (Licence: MO 118266) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2017-11-13 |