| NPI | 1063866424 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD60850778) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR 4290ATI) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2016-04-21 |
| Last Update Date | 2018-06-28 |