| NPI | 1104609379 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 10940) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2982) |
| 152W00000X Optometrist (Licence: PA OEG004102) | |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2024-01-22 |