| 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 |