| NPI | 1164006011 |
|---|---|
| Former Name | SAMANTHA LEE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT003402) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 3744) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-05-07 |
| Last Update Date | 2022-08-17 |