| NPI | 1053905653 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PR 749-450) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 10150T) |
| Enumeration Date | 2021-02-24 |
| Last Update Date | 2021-05-19 |