| NPI | 1124470323 |
|---|---|
| Former Name | MICHAELA MARIE BRUNGARDT |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 8895TG) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 8895T) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2017-03-05 |