| NPI | 1114941622 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901004802) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2002015499) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2020-01-06 |