| NPI | 1063827228 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5064) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: UT 9053197-9934) |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2017-05-05 |