| NPI | 1821557265 |
|---|---|
| Former Name | LATIESHA COLISE BUTTS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171W00000X Contractor (Licence: GA 171W00000X) |
| Additional Taxonomies | 171W00000X Contractor |
| Enumeration Date | 2019-03-15 |
| Last Update Date | 2019-03-15 |