| NPI | 1104811488 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD61684652) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AK 334) |
| 152W00000X Optometrist (Licence: KS 1550) | |
| 152W00000X Optometrist (Licence: CO 3846) | |
| Enumeration Date | 2005-09-13 |
| Last Update Date | 2025-08-18 |