| NPI | 1073706578 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004430) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 5725) |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2012-09-26 |