| NPI | 1003993601 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 3054) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR 2448) |
| 152W00000X Optometrist (Licence: ID 858) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2013-06-05 |