| NPI | 1134313489 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SD 655) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN LD 3086000) |
| 152W00000X Optometrist (Licence: CA 13299) | |
| Enumeration Date | 2007-08-29 |
| Last Update Date | 2013-11-08 |