| NPI | 1073185278 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 10323T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT003339.) |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2022-08-02 |