| NPI | 1053895144 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: LA 1904-840AT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR ATI-4407) |
| Enumeration Date | 2018-09-24 |
| Last Update Date | 2019-11-06 |