| NPI | 1013400795 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD60855208) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR 4379ATI) |
| 152W00000X Optometrist (Licence: AZ OPT-002297) | |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2023-12-20 |