| NPI | 1013193697 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2103) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 4643) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2010-08-09 |