| NPI | 1023662012 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO OPT.0003571) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT003171) |
| Enumeration Date | 2019-07-28 |
| Last Update Date | 2025-04-12 |