| NPI | 1073779948 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA MA 4988) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CT 002757) |
| 152W00000X Optometrist (Licence: MD TA2153) | |
| Enumeration Date | 2008-07-31 |
| Last Update Date | 2014-07-14 |