| NPI | 1063561066 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 2414) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 2614) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2015-05-05 |