| NPI | 1073129813 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT003408) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV009144-01) |
| Enumeration Date | 2020-09-17 |
| Last Update Date | 2022-09-08 |