| NPI | 1124083886 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA 001344) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO 1806) |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2007-07-08 |