| NPI | 1104070788 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC4874) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV007321) |
| 152W00000X Optometrist (Licence: NJ 27OA00618600) | |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2014-12-04 |