| NPI | 1205080504 |
|---|---|
| Former Name | LACIE ALISON WILES |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363AS0400X Physician Assistant, Surgical (Licence: TN 1684) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: TN 1665) |
| Enumeration Date | 2008-11-13 |
| Last Update Date | 2010-12-02 |