| NPI | 1154311801 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 002622) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 4297) |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2012-12-07 |