| NPI | 1154468890 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 2300) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: MN 2300) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2023-02-01 |