| NPI | 1023011228 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 3810) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: MA 3810) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2007-07-08 |