| NPI | 1104425479 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD61075611) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP-100542) |
| Enumeration Date | 2020-10-19 |
| Last Update Date | 2021-07-08 |