| NPI | 1063673028 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 4786) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001757) |
| 152W00000X Optometrist (Licence: MD TA2106) | |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2020-03-23 |