| NPI | 1003212044 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL 5220) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 5064) |
| Enumeration Date | 2014-11-18 |
| Last Update Date | 2018-05-21 |