| NPI | 1013242197 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3315) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG002668) |
| 152WV0400X Optometrist Vision Therapy (Licence: MN 3315) | |
| Enumeration Date | 2009-10-07 |
| Last Update Date | 2019-07-11 |