| NPI | 1124024302 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY 1082 DT) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: KY 1082DT) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2014-03-31 |