| NPI | 1104949338 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3109) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: MN 3109) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2010-05-20 |