| NPI | 1124003397 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 3100T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD00004038) |
| Enumeration Date | 2005-12-10 |
| Last Update Date | 2021-02-23 |