| NPI | 1164506390 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT002801) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 6699T) |
| 152W00000X Optometrist (Licence: VA 0618001816) | |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2014-06-11 |