| NPI | 1053660951 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4787) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO OPT.0002935) |
| Enumeration Date | 2012-09-06 |
| Last Update Date | 2014-10-22 |