| NPI | 1114507092 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 5471) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 118112) |
| 152W00000X Optometrist (Licence: WI 3941-35) | |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2024-01-09 |