| NPI | 1114596723 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2662) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 3732) |
| Enumeration Date | 2021-06-18 |
| Last Update Date | 2022-07-29 |