| NPI | 1003036427 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3600) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CT 002648) |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2020-08-11 |