| NPI | 1104837640 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 20080008323) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KS 1801) |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2019-07-08 |