| NPI | 1114582004 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CA 34569) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NV 1078) |
| 152W00000X Optometrist (Licence: OR 4455) | |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2021-10-13 |