| NPI | 1073754511 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD60307982) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046.010185) |
| Enumeration Date | 2009-03-12 |
| Last Update Date | 2013-01-22 |