| NPI | 1104268713 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MS 877) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT003388) |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2022-07-08 |