| NPI | 1114254281 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2012025596) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 13885) |
| Enumeration Date | 2009-11-11 |
| Last Update Date | 2020-03-03 |