| NPI | 1053535419 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 2519) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO 2569) |
| 152W00000X Optometrist (Licence: OR 3155T) | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2021-03-11 |