| NPI | 1104232081 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT002893) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618002353) |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2018-02-15 |