| NPI | 1104064583 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DC OP1000182) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001818) |
| Enumeration Date | 2009-01-23 |
| Last Update Date | 2009-04-29 |