| NPI | 1104471739 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 9833) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH T6911) |
| Enumeration Date | 2019-08-09 |
| Last Update Date | 2026-04-20 |