| NPI | 1104441054 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DE I3-0011431) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG003682) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-06-16 |
| Last Update Date | 2021-07-13 |