| NPI | 1114901360 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901003036) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL 2129) |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2018-12-14 |