| NPI | 1043880057 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD61181803) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR ATI4567) |
| Enumeration Date | 2021-06-30 |
| Last Update Date | 2023-07-28 |