| NPI | 1003194028 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618002480) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 6049) |
| Enumeration Date | 2011-07-25 |
| Last Update Date | 2017-02-27 |