| NPI | 1124058060 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00003556) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 10956T) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2015-12-29 |