NPI | 1427224617 |
---|---|
Former Name | LATOYA TANISHA LYLES |
Entity Type | Individual |
Gender | Female |
Sole Proprietor ? | No |
Primary Taxonomy | 363A00000X Physician Assistant (Licence: GA 005318) |
Additional Taxonomies | 363A00000X Physician Assistant (Licence: AL PA.825) |
363A00000X Physician Assistant (Licence: FL PA9105617) | |
Enumeration Date | 2008-05-07 |
Last Update Date | 2024-02-12 |