| NPI | 1104335801 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 9835T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00676400) |
| Enumeration Date | 2017-09-25 |
| Last Update Date | 2020-12-07 |