Individual
KYLE T LATHAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
903 MARQUETTE AVE NW, ALBUQUERQUE, NM 87102-1935
(505) 508-7293
Mailing address
903 MARQUETTE AVE NW, ALBUQUERQUE, NM 87102-1935
(505) 508-7293
Taxonomy
Speciality
Code
Description
License number
State
373H00000X
Day Training/Habilitation Specialist
Primary
—
—
Other
Enumeration date
06/28/2018
Last updated
06/28/2018
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