| NPI | 1063775781 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA 2768) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 1710) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2018-09-13 |