| NPI | 1023677424 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 10920) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901005386) |
| Enumeration Date | 2019-06-10 |
| Last Update Date | 2023-12-01 |