| NPI | 1124506852 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3591) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 6817) |
| Enumeration Date | 2018-08-03 |
| Last Update Date | 2023-03-29 |