| NPI | 1023468592 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003153) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2559) |
| Enumeration Date | 2016-06-15 |
| Last Update Date | 2016-10-08 |