| NPI | 1023686995 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901005531) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: MI 4901005531) |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2021-06-16 |