| NPI | 1164045159 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MI 4901005516) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH OPT.6869) |
| Enumeration Date | 2020-05-25 |
| Last Update Date | 2022-01-17 |