| NPI | 1104178094 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA OEG003023) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: MA 4941) |
| 152WP0200X Optometrist, Pediatrics (Licence: MD TA2382) | |
| 152WP0200X Optometrist, Pediatrics (Licence: VA 0618002276) | |
| 152WP0200X Optometrist, Pediatrics (Licence: DC OP1000276) | |
| Enumeration Date | 2012-10-03 |
| Last Update Date | 2022-08-26 |