| NPI | 1073900718 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3495) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ND 731) |
| Enumeration Date | 2015-04-21 |
| Last Update Date | 2017-05-10 |