| NPI | 1154606549 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 765) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DC OP581) |
| 152W00000X Optometrist (Licence: MD TA 0973) | |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2011-10-17 |