| NPI | 1083785596 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 06499) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 2034) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2007-07-08 |