| NPI | 1003267428 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VT 030-0129293) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG003147) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA OEG003147) | |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2018-06-13 |