| NPI | 1154844017 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3563) |
| Additional Taxonomies | 152WP0200X Optometrist Pediatrics (Licence: MN 3563) |
| 152WV0400X Optometrist Vision Therapy (Licence: MN 3563) | |
| Enumeration Date | 2017-07-24 |
| Last Update Date | 2023-02-05 |