| NPI | 1053490219 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IL 046-006808) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 1664) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2007-07-08 |