| NPI | 1043265267 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 2573) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 2652-035) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2023-03-25 |