| NPI | 1104916246 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY T005716) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OE007844) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-07-08 |