| NPI | 1104302660 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: MO 2019024861) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: NJ 27OA00681400) |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2020-05-28 |